The
Christian Brothers Employee Benefit Trust (the "Trust")
is sponsored by the Trustees elected by organizations
that have adopted the Trust. The Trustees are required
by law to provide you with a copy of the following
Notice ("Notice").
THE NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.
• How the Trust Will Use Your Information
The Trust may use, share or disclose the personal
health information the Trust creates, receives
or maintains about you ("protected health
information" or "PHI") to pay medical
benefits, operate the Trust or for treatment by
a health care provider. In addition,the Trust may
use or disclose your information in other special
circumstances described in the Notice. For any
other purpose, the Trust will require your written
authorization for the use or disclosure of your
protected health information.
• Your Individual Rights
You have the right to inspect your protected health
information, request an amendment of the information,
request restrictions on the use and disclosure of
the information, request that communications be made
to you through alternate means or at an alternative
location, and obtain an accounting of the information
that the Trust has disclosed for reasons other than
treatment, payment, health care operations, required
or authorized disclosures. There are certain limitations
on these rights as explained in the Notice.
• Questions and Complaints
You may contact the following person for more
information about the Trust's privacy practices,
to
exercise your rights or to complain about how the
Trust is handling your protected health information:
Chief Privacy Officer
Christian Brothers Services
1205 Windham Parkway
Romeoville, IL 60446-1679
cpo@cbservices.org
800.807.0100
NOTICE OF PRIVACY PRACTICES FOR CHRISTIAN BROTHERS EMPLOYEE BENEFIT TRUST
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
ACCESS TO YOUR INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. Why Am I Receiving This Notice?
The Christian Brothers Employee Benefit Trust (the "Trust")
is subject to the Health Insurance Portability and
Accountability Act of 1996, as amended ("HIPAA").
The Trust is sponsored by the Trustees elected by
organizations that have adopted the Trust. The privacy
of your personal health information that is created,
used, or disclosed by the Trust is protected by HIPAA.
The Trustees are required by law to:
• maintain the privacy of your protected health information ("PHI");
•provide
you with this Notice of the Trust's legal duties and privacy practices with respect
to
your PHI; and
• abide by the terms of this Notice.
2. What is PHI?
PHI, or protected health information, is the identifiable
health information about you created, received or
maintained by the Trust, regardless of the form or
medium of the information. It does not include employment
records held by your employer.
3. How will the Trust Use my PHI?
Under HIPAA, the Trust must disclose your PHI:
• to you or your legal representative when you ask for information;
•to
the U.S. Department of Health and Human Services, if necessary, to make sure
your privacy
is protected; and
• where otherwise required by
law.
The Trust, and the individuals who administer the
Trust, may use, receive or disclose your PHI for
treatment, payment or health care operations without
obtaining a written authorization from you. These
activities
cover a broad range of activities, including:
• Treatment - The Trust may disclose protected
health information to your providers for treatment,
including the provision of care (diagnosis, cure,
etc.) or the coordination or
management of that care.
• Payment - The Trust may use and disclose
your protected health information to pay benefits.
Payment activities may include receiving claims or
bills from your health care providers, processing
payments, sending explanations of benefits (EOBs)
to Trust participants, reviewing the medical necessity
of the services rendered, conducting claims appeals
and coordinating the payment of benefits between
multiple medical plans.
• Health Care Operations - The Trust may use
and disclose your protected health information for
Trust operational purposes. For example, the Trust
may use or disclose your protected health information
for Trust administration activities such as enrollment,
verification to your doctors or hospitals that you
are eligible for benefits under the Trust, disease
management programs and other Trust-related activities,
including audits of claims.
The Trust may also use and disclose your protected
health information to provide information to you
about disease management programs, treatment alternatives
or other health-related benefits and services that
may be of interest to you.
The Trust may contract with other businesses for
certain Trust administrative services. The Trust
may release your health information to one or more
of these "business associates" for Trust
administration if the business associate agrees in
writing to protect the privacy of your information.
The Trustees of the Trust, as the sponsor of the
Trust, as well as employees and agents of Christian
Brothers Services, the organization selected by the
Trustees to administer the Trust, will also have
access to your protected health information for Trust
administration purposes. Access to your protected
health information by Trustees or employees of Christian
Brothers Services will be limited to persons responsible
for Trust administration.
Unless you authorize the Trust otherwise in writing
(or the individually identifying data is deleted
from the information), your protected health information
will be available only to individuals who need the
information to conduct these Trust administration
activities and the release of your PHI will be limited
to the minimum disclosure required, unless otherwise
permitted or required by law.
4. Under What Circumstances Would My PHI be Released
for Other than Trust Administration?
The Trust is also permitted to use or disclose your
protected health information, without obtaining a
written authorization from you, in the following
circumstances:
•
For certain required public health activities (such
as reporting disease outbreaks);
•
To prevent serious harm to you or other potential
victims, where abuse, neglect or domestic violence
is involved;
• For health oversight agency for oversight
activities authorized by law;
• In the course of any judicial or administrative
proceeding in response to a court or administrative
tribunal's order, subpoena, discovery request or
other lawful process;
• For a law enforcement purpose to a law enforcement
official if certain legal conditions are met (such
as providing limited information to locate a missing
person);
• For research studies that meet all privacy
law requirements (such as research related to the
prevention of disease or disability);
• To avert a serious threat to the health
or safety of you or any other person; and
• To the extent necessary to comply with laws
and regulations related to workers' compensation
or similar programs.
Any other use or disclosure of your protected health
information not identified within this Notice will
be made only with your written authorization.
5. Does My State Privacy Law Also Apply to PHI?
If your applicable state laws provide more stringent
privacy protections than HIPAA, the more stringent
state law will apply to protect your rights. If
you have a question about your rights under any
particular federal or state law, please contact
the person identified in section 9 as the Privacy
Contact.
6. How Do I Authorize a Release of My PHI?
You will need to complete a written authorization
form. An authorization form is available from our
website, www.cbservices.org, or by calling us at
800-807-0100.
You have the right to limit the type of information
that you authorize the Trust to disclose and the
persons to whom it should be disclosed. You may revoke
your written authorization at any time, and the revocation
will be followed to the extent action on the authorization
has not yet been taken.
7. What Are My Individual Rights With Respect to
My PHI?
You have the right to:
• Request the Trust to restrict its uses and
disclosures of your PHI. However, the Trust is not
required to agree to a requested restriction. To
request a restriction, please write to the Privacy
Contact (identified at the end of this Notice) and
provide specific information as to the disclosures
that you wish to restrict and the reasons for your
request. The Privacy Contact will respond in writing.
• Request that the Trust's confidential communications
of your PHI be sent to another location or by alternative
communicative means. For example, you may ask that
we send all explanation of benefits statements (EOBs)
to your office rather than your home address. The
Trust is not required to accommodate your request
unless your request is reasonable and you state that
the Trust's ordinary communication process could
endanger you.
• To inspect and obtain a copy of the PHI
held by the Trust. However, access to psychotherapy
notes, information compiled in reasonable anticipation
of, or for use in legal proceedings and under certain
other, relatively unusual, circumstances may be denied.
Your request should be made in writing. A reasonable
fee may be imposed for copying and mailing the requested
information.
• Request that the Trust amend your protected
health information or record if you believe the information
is incorrect or incomplete.
• Receive a list of those individuals or entities
who have accessed your PHI for reasons other than
for treatment, payment or Trust operations or that
you have authorized in writing.
• Get a paper copy of this Notice at any time,
even if you have agreed to receive it electronically.
8. How Do I Make A Complaint If I Think My Rights
Have Been Violated?
You may file a complaint with the Trust's Privacy
Contact and with the Secretary of the Department
of Health and Human Services. Their addresses are
available under contact information below. All complaints
must be filed in writing. You will not be retaliated
against for filing a complaint.
9. Who Is the Trust's Privacy Contact?
If you have any questions about this Notice, please
contact the Trust's Privacy Contact:
Chief Privacy Officer
Christian Brothers Services
1205 Windham Parkway
Romeoville, IL 60446-1679
cpo@cbservices.org
800.807.0100
10. How Do I Contact The Federal Government If I
Want To Make a Complaint or Inquiry?
To contact the Secretary of Health and Human Services,
write to:
U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll free: 1-877-696-6775
http://www.hhs.gov/contacts/privacy.html
11. What is the Effective Date of This Notice?
The effective date of this Notice is April 14, 2003.
12. Can This Notice Be Changed?
The Trust reserves the right to change the terms of this Notice and its information
practices and to make new provisions effective for all protected health information
it maintains. Any amended Notice will be provided to you.
|