Ntice f Privacy Practices fr the S.U. Theatre Crpratin Health Benefits Plan Ntice THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION. PLEASE REVIEW IT CAREFULLY. This Ntice f Privacy Practices ("NPP") is made in cmpliance with the Standards fr Privacy f Individually Identifiable Health Infrmatin (the "Privacy Standards") established by the United States Department f Health and Human Services ("DHHS") pursuant t the Health Insurance Prtability and Accuntability Act f 1996 ("HIPAA"). This NPP summarizes the privacy practices f the S.U. Theatre Crpratin Health Benefits Plan ( Plan ). The Privacy Standards shall cntrl in the event f a discrepancy between this NPP and the Privacy Standards. The Plan is required by law t maintain the privacy f yur Prtected Health Infrmatin ("PHI") as defined belw, and t infrm yu, thrugh this NPP, abut: 1. the Plan's duties with respect t yur PHI; 2. hw the Plan may use and disclse yur PHI; 3. yur privacy rights with respect t yur PHI; 4. yur right t file a cmplaint with the Plan and with the Secretary f DHHS; and 5. wh t cntact fr further infrmatin abut the Plan s privacy practices. PHI, as defined by HIPAA, includes all individually identifiable infrmatin abut yu that is transmitted r maintained by the Plan, including demgraphic infrmatin, and includes infrmatin that is created r received by the Plan that relates t: yur past, present r future physical r mental health r cnditin; the prvisin f health care services t yu; r the past, present, r future payment fr the prvisin f health care t yu. The Plan is required t abide by the terms f the NPP that is currently in effect fr the Plan. The Plan reserves the right t revise r amend the terms f this NPP. Any revisin r amendment will be effective fr all recrds that the Plan has created r maintained in the past, and fr any f yur recrds that may be created r maintained in the future. Yu will be infrmed f any material changes made t this NPP. In additin, the Plan will pst, at all times, a cpy f its mst current NPP nline at http://syracusestage.rg/staff.php. Yu may als btain a cpy f the mst current NPP at any time by calling the Syracuse University Office f Human Resurces at 315.443.4042. If yu have any questins abut this NPP r wuld like further infrmatin abut HIPAA, please cntact the Syracuse University Office f Human Resurces at 315.443.4042. HOW THE PLAN MAY USE AND DISCLOSE YOUR PHI HIPAA permits the Plan, its Business Assciates, and their agents/subcntractrs, if any, t use and/r disclse yur PHI, withut prir authrizatin, fr the purpses f treatment, payment, and ther health care peratins f the Plan, which are described belw. Cnsistent with the Genetic Infrmatin Nndiscriminatin Act (GINA), the Plan is prhibited frm using r disclsing genetic infrmatin fr underwriting purpses. The Plan will disclse yur PHI t
its Business Assciates nly if it has received satisfactry assurances that the Business Assciates will apprpriately safeguard yur PHI. HIPAA als permits the Plan t use and disclse f yur PHI, withut prir authrizatin, fr ther specific purpses that are als described belw. Fr each categry, a descriptin and sme examples f the permitted uses and/r disclsures has been prvided. The fllwing examples are illustrative and are nt meant t be a cmplete descriptin f the permitted uses and disclsures f the Plan. A. Treatment. The Plan may use and/r disclse yur PHI t health care prviders wh are invlved in yur care and treatment. The Plan may use r disclse PHI abut yu t physicians, nurses, paraprfessinals, technicians, r ther health care prviders wh are invlved in yur care and treatment. Fr example, the Plan may disclse yur PHI t a physician r a pharmacy t assist in the management f yur health care. B. Payment. The Plan may use and/r disclse yur PHI t fulfill its bligatin fr cverage and the prvisin f health benefits under the Plan. Fr example, the Plan may use r disclse PHI t btain r prvide reimbursement fr the prvisin f health care. Payment includes, but is nt limited t, actins relating t eligibility r cverage determinatins, billing, claims management, cllectin activities, reviews fr medical necessity determinatins and apprpriateness f care, utilizatin review and pre-authrizatins. C. Health Care Operatins. The Plan may use and/r disclse PHI in rder t cnduct its nrmal business peratins. Fr example, the Plan may use yur PHI t cnduct quality assessment and imprvement activities, ppulatin-based activities relating t imprving r reducing health care csts, cntacting health care prviders and patients with infrmatin regarding treatment alternatives, reviewing the cmpetence r qualificatins f health care prfessinals, evaluating health plan perfrmance, and ther insurance related activities. D. Fllw up Telephne Calls/Emails. The Plan may call yu t fllw up n care r treatment yu received by a health care prvider, r t ask questins relating t treatment, payment, r ther health care peratins f the Plan. E. Treatment Alternatives r Other Health-Related Benefits and Services. The Plan may use and/r disclse PHI t tell yur health care prviders abut r recmmend pssible treatment alternatives r healthrelated benefits r services that may be f interest t yu r yur health care prvider. F. Individuals Invlved in Yur Care r Payment fr Yur Care. HIPAA permits the Plan t disclse PHI t a family member, ther relative, a clse persnal friend, r any ther persn identified by yu if: 1. yu are present fr, r therwise available prir t the disclsure and the Plan has either btained yur agreement t the disclsure, prvided yu the pprtunity t bject t the disclsure, r the Plan has reasnably inferred frm the circumstances that yu d nt bject t the disclsure; 2. due t yur incapacity r an emergency circumstance the Plan has determined that a disclsure is in yur best interest - in such circumstances, the Plan will nly disclse PHI that is directly relevant t the persn's invlvement with yur health care. G. As Required By Law. The Plan may use and/r disclse yur PHI as required t d s under any federal, state r lcal law.
H. Public Health Risks. The Plan may use and/r disclse yur PHI t authrized public health fficials (r a freign gvernment agency cllabrating with such fficials) s such fficials may carry ut public health activities. Fr example, the Plan may disclse yur PHI t public health fficials fr the fllwing reasns: 1. t prevent r cntrl disease, injury r disability; 2. t reprt vital events such as births and deaths; 3. t reprt child abuse r neglect; 4. t reprt quality, safety r effectiveness f FDA-regulated prducts r activities; 5. t ntify peple f prduct recalls they may be using; 6. t ntify a persn wh may have been expsed t a cmmunicable disease r may be at risk fr cntracting r spreading a disease r cnditin; r 7. t yur emplyer, in rder t cmply with emplyment laws. I. Victims f Abuse, Neglect, r Dmestic Vilence. The Plan may disclse yur PHI t gvernment authrities, including a scial service r prtective services agency, authrized by law t receive reprts f abuse, neglect r dmestic vilence. Fr example, the Plan may reprt yur PHI t gvernment fficials if it reasnably believes that yu have been a victim f abuse, neglect r dmestic vilence. The Plan will make every effrt t btain yur permissin befre releasing this infrmatin, hwever, in sme cases the Plan may be required r authrized t act withut yur permissin. J. Health Oversight Activities. The Plan may disclse yur PHI t a health versight agency fr activities authrized by law. These agencies typically mnitr the peratin f the health care system, gvernment benefits prgrams, and cmpliance with gvernment regulatry prgrams. The versight activities may include audits; civil, criminal, r administrative investigatins r actins; inspectins; and/r licensure r disciplinary actins. K. Lawsuits and Similar Prceedings. The Plan may use r disclse yur PHI in respnse t a curt r administrative rder, if yu are invlved in a lawsuit r similar prceeding. The Plan may als disclse yur PHI in respnse t a discvery request, subpena, r ther lawful prcess that is nt accmpanied by an rder f a curt r administrative tribunal, but nly if the Plan has first received satisfactry assurances frm the party requesting the infrmatin that reasnable effrts have been made t infrm yu f the request, r if the Plan has received satisfactry assurances that effrts have been made by the party seeking the infrmatin t btain a qualified prtective rder. A qualified prtective rder is an rder f a curt r an administrative tribunal r a stipulatin by parties t the litigatin that prhibits the parties frm using r disclsing PHI fr any purpse ther than the litigatin r prceeding. A qualified prtective rder will require the return f PHI t the Plan at the end f the litigatin r prceeding. L. Law Enfrcement Purpses. The Plan may disclse yur PHI t law enfrcement fficials fr the fllwing reasns: in respnse t curt rders, warrants, subpenas, r summns r similar legal prcess; t assist law enfrcement fficials with identifying r lcating a suspect, fugitive, material witness, r missing persn; if yu have been r are suspected f being a victim f a crime and yu agree t the disclsure, r if the Plan is unable t btain yur agreement because f incapacity r ther emergency; if the Plan suspects that a death resulted frm criminal cnduct;
t reprt evidence f criminal cnduct that ccurred n ur premises; in respnse t a medical emergency, t reprt a crime (including the lcatin r victims f the crime; r the identity, descriptin r lcatin f the persn wh cmmitted the crime). M. Crners, Medical Examiners and Funeral Directrs. The Plan may disclse yur PHI t a crner r medical examiner fr the purpse f identifying a deceased persn, determining cause f death, r ther duties as authrized by law. The Plan may als release PHI t funeral directrs as necessary t carry ut their duties. N. Organ, Eye, r Tissue Dnatin Purpses. The Plan may use r disclse yur PHI t rgan prcurement rganizatins r ther entities engaged in the prcurement, banking, r transplantatin f rgans, eyes, r ties fr the purpse f facilitating dnatin and transplantatin. O. Research. In mst cases, the Plan will ask fr yur written authrizatin befre using and/r disclsing yur PHI t cnduct research. Hwever, in limited circumstances the Plan may use and/r disclse PHI withut authrizatin if: (i) the use r disclsure was apprved by an Institutinal Review Bard r a Privacy Bard; and (ii) the Plan btains representatins frm the researcher that the infrmatin is necessary fr the research prtcl, PHI will nt be remved frm ur lcatin, and the infrmatin will be used slely fr research purpses; r (iii) the PHI sught by the researcher relates nly t decedents and the researcher agrees that the use r disclsure is necessary fr the research. P. Uses that Require Yur Written Authrizatin. Any use r disclsure f any PHI fr marketing purpses and disclsures that cnstitute the sale f PHI require yur written authrizatin; Psychtherapy ntes will nly be used and disclsed with yur written authrizatin; Any ther uses and disclsures nt specified in this Ntice require yur written authrizatin. Q. T Avert Serius Threat t Health r Safety. The Plan may use r disclse yur PHI when necessary t prevent r lessen a serius and imminent threat t yur health r safety, r the health r safety f anther persn r the public. In such cases, the Plan will nly share yur PHI with a persn r persns reasnably able t prevent r lessen the threat, including the target f the threat; r if it is necessary fr law enfrcement authrities t identify r apprehend an individual. R. Specialized Gvernment Functins. The Plan may use and disclse PHI regarding: Military and veteran activities; Intelligence, cunter-intelligence, and ther natinal security activities authrized by law; Prtective services fr the President, t freign heads f state, r t ther persns authrized by law; Inmates t a crrectinal institutin r a law enfrcement fficial having lawful custdy f an inmate r ther individual. S. Wrkers' Cmpensatin. The Plan may disclse yur PHI fr wrkers' cmpensatin r ther similar prgrams that prvide benefits fr wrk-related injuries r illnesses.
Except as therwise indicated in this NPP, uses and disclsures fr all ther purpses will be made nly with yur written authrizatin. Yu may revke an authrizatin at any time, prvided that yur revcatin is dne in writing, and except t the extent that the Plan has already relied upn yur authrizatin. YOUR RIGHTS REGARDING YOUR PHI HIPAA prvides yu with the fllwing rights regarding the PHI the Plan maintains abut yu: A. Right t Inspect and Cpy. Yu have the right t inspect and receive a cpy f yur PHI cntained in a "designated recrd set" fr as lng as the Plan maintains the PHI in the designated recrd set, except fr psychtherapy ntes; infrmatin cmpiled in reasnable anticipatin f, r fr use in, a civil, criminal, r administrative actin r prceeding; and PHI maintained by the Plan that is subject t the Clinical Labratry Imprvements Amendments f 1988. If yur PHI is in an electrnic file, yu may request an electrnic cpy f the recrd. A "designated recrd set" is a grup f recrds maintained by r fr a health plan that is the enrllment, payment, claims adjudicatin, and case r medical management recrd systems maintained by r fr a health plan; r use in whle r in part, by r fr the health plan t make decisins abut individuals. T inspect r btain a cpy f yur PHI cntained in a designated recrd set, please submit a request in writing t the Office f Human Resurces at Syracuse University, Skytp Office Building, Suite 101, 640 Skytp Rad, Syracuse, New Yrk 13244-5300. If yu request a cpy f yur recrd set, the Plan may charge a fee fr the csts f cpying, mailing r ther supplies used t fulfill yur request. The standard fee is $0.75 per page and must generally be paid befre r at the time the Plan prvides yu with cpies f yur PHI. The Plan will respnd t yur request fr inspectin f recrds within 10 days, and will respnd t requests fr cpies within 30 days if the infrmatin is lcated within ur facility and within 60 days if the infrmatin is lcated ff-site at anther facility. If the Plan needs additinal time t respnd t yur request fr cpies, yu will be ntified in writing within the timeframe abve t explain the reasn(s) fr such delay and when yu can expect t have a final answer t yur request. Under certain circumstances, the Plan may deny yur request t inspect r btain a cpy f yur PHI. If yur request fr inspectin is denied, the Plan will prvide yu with a written ntice explaining ur reasns fr such denial, and will include a cmplete descriptin f yur rights t have the decisin reviewed and hw yu can exercise thse rights. B. Right t Amend. Yu have the right t request that the Plan amend yur PHI r a recrd abut yu in a designated recrd set fr as lng as the infrmatin is kept by the Plan, if yu feel that the PHI the Plan has abut yu is incrrect r incmplete. The Plan may deny yur request fr amendment if it determines that the PHI r recrd that is the subject f the request: was nt created by the Plan, unless yu prvide a reasnable basis t believe that the riginatr f the PHI is n lnger available t act n the requested amendment; is nt part f the designated recrd set; wuld nt be available fr yur inspectin under the Privacy Standards (as described in Right t Inspect and Cpy Sectin, abve); r is accurate and cmplete.
T request an amendment, yur request must be made in writing and submitted t the Office f Human Resurces at Syracuse University, Skytp Office Building, Suite 101, 640 Skytp Rad, Syracuse, New Yrk 13244-5300. In additin, yur request shuld include the reasns(s) why yu believe the Health Plans shuld amend yur PHI. The Plan will respnd t yur request fr amendment n later than 60 days after the receipt f yur request. If the Plan needs additinal time t respnd t yur request, yu will be ntified in writing within 60 days t explain the reasn(s) fr the delay and the date by which it will cmplete yur request. If the Plan denies yur request fr an amendment, it will prvide yu with a written ntice f the denial that explains the reasns fr ding s. Yu will have the right t submit a written statement disagreeing with the denial. Yu will als be infrmed f hw t file a cmplaint with the Plan r with the Secretary f the DHHS. These prcedures will be explained in greater detail in any written denial ntice. C. Right t an Accunting f Disclsures. Yu have the right t request an "accunting f disclsures." An "accunting f disclsures" is a list f disclsures the Plan has made regarding yur PHI. An accunting f disclsures will include all disclsures except the fllwing: Disclsures t carry ut treatment, payment, and health care peratins; Disclsures made t yu; Disclsures made pursuant t yur authrizatin; Disclsures made in a facility directry r t persns invlved in yur care; Disclsures fr natinal security r intelligence purpses; Disclsures t crrectinal institutins r law enfrcement fficials; r Disclsures made befre April 14, 2003. The accunting f disclsures will be in a frmat that is cnsistent with the requirements f the Privacy Standards. T request an accunting f disclsures, yu must submit yur request in writing t the Office f Human Resurces at Syracuse University, Skytp Office Building, Suite 101, 640 Skytp Rad Syracuse, New Yrk 13244-5300. Yur request must include a time perid f requested disclsures, which may nt be lnger than six years and may nt include dates befre April 14, 2003. The first list yu request within a 12- mnth perid will be free. Additinal lists within the same 12 mnth perid will be assessed a charge fr the csts f prviding the list. The Plan will ntify yu f the cst invlved, at which time yu may chse t withdraw r mdify yur request befre any csts are incurred. The Plan will respnd t yur request fr an accunting f disclsures within 60 days frm the receipt f such request. If the Plan needs additinal time t prepare the accunting, they will ntify yu in writing within 60 days abut the reasn fr the delay and prvide yu with the date when yu can expect t receive the accunting. D. Right t Receive Ntificatins f Breaches. Yu have the right t receive ntificatins f breaches f yur unsecured PHI. Yu need nt specifically request such ntificatin; it will be prvided t the extent required by the privacy rules. E. Right t Request Restrictins. Yu have the right t request a restrictin r limitatin n the PHI the Plan uses r disclses abut yu fr treatment, payment r health care peratins. Yu als have the right t request a limit n the medical infrmatin that the Plan disclses abut yu t smene wh is invlved in yur care, like a family member, relative, friend, r ther persn(s) identified by yu.
The Plan is nt required t agree t yur request fr restrictin. If the Plan agrees t a requested restrictin, the Plan may nt use r disclse PHI in vilatin f such restrictin, unless the infrmatin is needed t prvide yu with emergency care r treatment, r as therwise required by law. Under certain circumstances, the Plan may terminate its agreement t a restrictin. T request restrictins, yu must make yur request in writing t the Office f Human Resurces at Syracuse University, Skytp Office Building, Suite 101, 640 Skytp Rad, Syracuse, New Yrk 13244-5300. In yur request, yu must tell us (1) what infrmatin yu want t limit; (2) whether yu want t limit ur use, disclsure r bth; and (3) t whm yu want the limits t apply, fr example, disclsures t yur spuse. F. Right t Request Cnfidential Cmmunicatins. Yu have the right t request that the Plan cmmunicates with yu abut yu and yur PHI in a certain way r at a certain lcatin. Fr example, yu can ask that the Plan cntacts yu nly at wrk r by mail. The Plan will nt ask yu the reasn fr yur request, and will accmmdate all reasnable requests. Yur request must specify hw r where yu wish t be cntacted, and hw payment fr yur health care will be handled if we cmmunicate with yu thrugh this alternative methd r lcatin. T request cnfidential cmmunicatins, yu must make yur request in writing t the Office f Human Resurces at Syracuse University, Skytp Office Building, Suite 101, 640 Skytp Rad, Syracuse, New Yrk 13244-5300. G. Right t Receive a Paper Cpy f This NPP. Yu have the right t receive a paper cpy f this NPP at any time. Even if yu have agreed t receive this NPP electrnically, yu are still entitled t a paper cpy f this NPP. T btain a cpy f this NPP please cntact the Syracuse University Office f Human Resurces at 315.443.4042. COMPLAINTS If yu believe yur privacy rights have been vilated, yu may file a cmplaint with the Privacy Official at the Office f Human Resurces at Syracuse University, with Syracuse University's Privacy Officer, and/r with the Secretary f the DHHS. T file a cmplaint with the Privacy Official at the Office f Human Resurces at Syracuse University, please submit a written cmplaint t Privacy Official, Office f Human Resurces at Syracuse University, Skytp Office Building, Suite 101, 640 Skytp Rad, Syracuse, New Yrk 13244-5300. T file a cmplaint with Syracuse University's Privacy Officer, please submit a written cmplaint t Privacy Officer, Office f Risk Management and Regulatry Cmpliance Services, 119 Euclid Avenue, Syracuse, NY 13244. The Plan will nt retaliate against yu fr filing a cmplaint with a Privacy Official f Syracuse University, r with Secretary f the DHHS. CONTACT PERSON If yu have any questins abut this Ntice f Privacy Practices r subjects addressed in it, please cntact: Privacy Official Office f Human Resurces at Syracuse University, Skytp Office Building, Suite 101, 640 Skytp Rad Syracuse, New Yrk 13244-5300 315.443.5462.