FIRST UNITED AMERICAN
LIFE INSURANCE COMPANY
HEALTH INSURANCE NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice gives you information required by the privacy
provisions of the Health Insurance Portability and Accountability Act
of 1996 and its implementing regulations (HIPAA Privacy Rules) about
the duties and privacy practices of First United American Life
Insurance Company to protect the privacy of your medical information
that we maintain
as
an issuer of health insurance policies that provide medical care benefits.
We sent this Notice to you because our records show that we provide health
care benefits to you under an individual or group health insurance policy
that provides medical care benefits.
This Notice applies to the designated health care components of First United American Life Insurance Company that use and disclose your medical information to provide medical care benefits to you under health insurance policies. We use the terms health and health care in this Notice to refer to the medical care benefits we provide to you. This Notice does not apply to the information that our non-health care components maintain about you as an issuer of life, disability, accident, indemnity or any other non-health insurance policy.
THE EFFECTIVE DATE OF THIS NOTICE IS APRIL 14, 2003. We are required to follow the terms of this Notice until we replace it. We reserve the right to change the terms of this Notice at any time. If we make changes to this Notice, we will revise it and send a new Notice to all persons to whom we are required to give the new Notice. We reserve the right to make the new changes apply to all your medical information maintained by us before and after the effective date of the new Notice.
Purposes for which We May Use
or Disclose Your Medical Information Without
Your Consent or Authorization
We may use and disclose your medical information for the following purposes:
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Health Care Providers Treatment
Purposes. For example, we may disclose your medical
information to your doctor, at the doctors request, for your
treatment by him.
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Payment. For example, we may use or
disclose your medical information to collect premiums, to pay claims
for covered health care services or to provide eligibility
information to your doctor when you receive treatment. We may also
use and disclose your medical information to another covered entity
or health care provider for the payment activities of the entity
that receives your medical information.
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Health Care Operations. For example,
we may use or disclose your medical information (i) to conduct
quality assessment and improvement activities, (ii) for
underwriting, premium rating, or other activities relating to the
creation, renewal or replacement of a contract of health insurance,
(iii) to authorize business associates to perform data aggregation
services, (iv) to engage in care coordination or case management,
and (v) to manage, plan or develop our business. We may also
disclose your medical information to another covered entity for the
limited health care operations activities and health care fraud and
abuse compliance activities of the entity that receives your medical
information.
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Health Services. We may use your
medical information to contact you to give you information about
treatment alternatives or other health-related benefits and services
that may be of interest to you. We may disclose your medical
information to our business associates to assist us in these
activities.
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As required by
law. For example, we must allow the U.S. Department of
Health and Human Services to audit our records. We may also disclose
your medical information as authorized by and to the extent
necessary to comply with workers compensation or other similar
laws.
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To Business Associates. We may
disclose your medical information to business associates we hire to
assist us. Each of our business associates must agree in writing to
ensure the continuing confidentiality and security of your medical
information.
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To Plan Sponsor. If we provide
health benefits to you under a group health plan, we may disclose to
the plan sponsor of your group health plan, in summary form, claims
history and other similar information. Such summary information does
not disclose your name or other distinguishing characteristics. We
may also disclose to the plan sponsor the fact that you are enrolled
in, or disenrolled from the group health plan. We may disclose your
medical information to the plan sponsor for administrative functions
that the plan sponsor provides to the group health plan if the plan
sponsor agrees in writing to ensure the continuing confidentiality
and security of your medical information. The plan sponsor must also
agree not to use or disclose your medical information for
employment-related activities or for any other benefit or benefit
plans of the plan sponsor.
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We may also use and disclose your medical information as follows:
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To comply with legal proceedings, such as a
court or administrative order or subpoena.
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To law enforcement officials for limited law
enforcement purposes.
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To a family member, friend or other person, for
the purpose of helping you with your health care or with payment for
your health care, if you are in a situation such as a medical
emergency and you cannot give your agreement to us to do this.
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To your personal representatives appointed by
you or designated by applicable law.
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For research purposes in limited circumstances.
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To a coroner, medical examiner, or funeral
director about a deceased person.
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To an organ procurement organization in limited
circumstances.
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To avert a serious threat to your health or
safety or the health or safety of others.
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To a governmental agency authorized to oversee
the health care system or government programs.
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To federal officials for lawful intelligence,
counterintelligence and other national security purposes.
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To public health authorities for public health
purposes.
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To appropriate military authorities, if you are
a member of the armed forces.
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Potential Impact of State Law
In some situations, the HIPAA Privacy Rules do not preempt (or take precedence over) state privacy laws that give you greater privacy protections. As a result, the privacy laws of a particular state might impose a privacy standard under which we will be required to operate (for example, a state privacy law relating to disclosures of medical information of minors).
Uses and Disclosures with Your Permission
We will not use or disclose your medical information for any other purposes unless you give us your written authorization to do so. If you give us written authorization to use or disclose your medical information for a purpose that is not described in this Notice, then, in most cases, you may revoke it in writing at any time. Your revocation will be effective for all your medical information we maintain, unless we have taken action in reliance on your authorization.
Your Rights
You may make a written request to us to do one or more of the following concerning your medical information that we maintain:
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To put additional restrictions on our use and
disclosure of your medical information. We do not have to agree to
your request.
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To communicate with you in confidence about your
medical information by a different means or at a different location
than we are currently doing. We do not have to agree to your request
unless such confidential communications are necessary to avoid
endangering you and your request continues to allow us to collect
premiums and pay claims. Your request must specify the alternative
means or location. Even though you requested that we communicate
with you in confidence, we may give subscribers cost
information.
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To see and get copies of your medical
information. In limited cases, we do not have to agree to your
request.
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To correct your medical information. In some
cases, we do not have to agree to your request.
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To receive a list of disclosures of your medical
information that we and our business associates made for certain
purposes for the last 6 years (but not for disclosures before April
14, 2003).
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To send you a paper copy of this Notice if you
received this Notice by email or on the Internet.
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If you want to exercise any of these rights described in this Notice, please contact the Contact Office (below). We will give you the necessary information and forms for you to complete and return to the Contact Office. In some cases, we may charge you a nominal, cost-based fee to carry out your request.
Complaints
If you believe we have violated your privacy rights, you have the right to complain to us or to the Secretary of the U.S. Department of Health and Human Services. You may file a complaint with us at our Contact Office (below). We will not retaliate against you if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Contact Office
To request additional copies of this Notice or to receive more information about our privacy practices or your rights, please contact us at the following Contact Office:
First United American Life Insurance Company
Privacy Office
P. O. Box 3125
Syracuse, New York 13220-3125
Telephone: 1-315-451-2544
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