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Magnus Group, Inc.
Employee Assistance Plan and Flexible Benefits Plan
P.O. Box 278
Emigsville, PA 17318
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.
We are required by law to maintain the privacy of your protected
health information (PHI). We are obligated to provide you with
a copy of this Notice of our legal duties and of our privacy
practices with respect to PHI and we must abide by the terms
of this Notice. We reserve the right to change the provisions
of our Notice and make the new provisions effective for all
PHI we maintain. If we make a material change to our Notice,
we will mail a revised Notice to the address that we have on
record for the policyholder.
This Notice describes the Magnus Group, Inc. employee assistance
plan and flexible benefits plan (hereinafter collectively referred
to as the “Plan”) practices in connection with the
use and disclosure of your medical information, your rights
and certain obligations we have regarding the use and disclosure
of your medical information. If you have any questions about
this notice, please contact the Plan’s Privacy Officer
at the address listed above.
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Effective
Date: This Notice of Privacy Practice becomes effective
as of April 14, 2004.
PRIMARY USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Payment: We may use or
disclose your PHI to pay claims for services provided to you
and to fulfill our responsibilities for plan coverage and providing
plan benefits. For example, we may disclose your PHI when a
provider (doctor, hospital, clinic, etc.) requests information
regarding your eligibility for coverage under the Plan, or we
may use your information to determine if a treatment that you
received was medically necessary.
Health
Care Operations: We may use or disclose your PHI
to support our business functions. These functions include,
but are not limited to: medical care, quality assessment and
improvement, stop-loss insurance underwriting, business planning,
and business development. For example, we may use or disclose
your PHI: (i) to provide you with information about one of our
health management programs; (ii) to respond to a customer service
inquiry from you; or (iii) in connection with fraud and abuse
detection and compliance programs.
Business
Associates:We
contract with individuals and entities (Business Associates)
to perform various functions on our behalf or to provide certain
types of services. To perform these functions or to provide
their services, our Business Associates will receive, create,
maintain, use, or disclose PHI, but only after we require the
Business Associates to agree in writing to contract terms designed
to appropriately safeguard your information. For example, we
may disclose your PHI to a Business Associate to administer
claims or to provide service support, utilization management,
subrogation, or pharmacy benefit management.
Other
Covered Entities: We may use or disclose your PHI
to assist other covered entities in connection with payment
activities and certain health care operation. For example, we
may disclose or share your PHI with other insurance carriers
in order to coordinate benefits, if you or your family members
have coverage through another carrier.
PERMITTED
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Personal Representatives:
We may disclose PHI to the patient or the patient’s personal
representative. A personal representative is a legal guardian,
or a person designated by you to act on your behalf in making
decisions related to your health care.
Public
Health Activities: We may disclose PHI to report
health information to public health authorities for the purpose
of preventing or controlling disease, injury or disability.
Abuse or Neglect:
If we believe you are the victim of abuse or neglect, we may
disclose PHI to a government authority such as social services
or protective services agency.
Health
Oversight Activities: We may disclose PHI to a health
oversight agency that oversees the health care system and is
charged with responsibility for ensuring compliance.
Legal Proceedings:We may disclose PHI in the course of a judicial or administrative
proceeding in response to legal order or other lawful process.
Law Enforcement Officials: We
may disclose PHI to the police or other officials in compliance
with a court order or subpoena.
Organ
& Tissue Procurement: We may disclose PHI to
organizations that facilitate organ, eye or tissue procurement,
banking or transplantation.
Coroners:
We may disclose PHI to a medical examiner as authorized by law.
Specialized Government Functions:
We may use and disclose PHI to units of the government with
special functions such as the U.S. military or the U.S. Department
of State.
Workers’
Compensation: We may disclose PHI as authorized
by and to the extent necessary to comply with laws relating
to workers’ compensation or other similar programs.
Health & Safety:We may use and disclose PHI, if in good faith, we believe
it is necessary to prevent or lessen a serious and imminent
threat to the health & safety of a person or the public.
As Required by Law:
We may use and disclose PHI when required to do so by any other
law not already referred to in the preceding categories.
To the Plan Sponsor:
We may disclose your PHI to the plan sponsors of the group health
plan for purposes of plan administration.
Others
Involved in Your Care:We may disclose your PHI known to a family member, relative
or close personal friend that you identify. Such a use will
be based on how involved the person is in your care. If you
are not present or able to agree to these disclosures of your
PHI, then, using our professional judgment, we may determine
whether the disclosure is in your best interest.
RIGHTS
Right to Inspect and Copy:
You have the right to inspect and copy your PHI that is contained
in a “designated record set.” A “designated
record set” contains your medical and billing records,
as well as other records that are used to make decisions about
your health care benefits. However, you may not inspect or copy
psychotherapy notes or certain other information that may be
contained in a designated record set.
Right
to Amend: If you believe that your PHI is incorrect
or incomplete, you may request that we amend your information.
In certain cases, we may deny your request for an amendment.
For example, we may deny your request if the information you
want to amend is not maintained by us, but by another entity.
Right of an Accounting:
You have a right to an accounting of certain disclosures of
your PHI that are made for reasons other than claim payment
or health care operations. No accounting of disclosures is required
for disclosures you authorized. You should know that most disclosures
of your PHI will be for purposes of claim payment or health
care operations, and, therefore, will not be subject to your
right to an accounting.
Right
to a Paper Copy of this Notice: You have the right
to a paper copy of this Notice, even if you may have agreed
to accept this Notice electronically.
COMPLAINTS
You may complain to us if you believe that we have violated
your privacy rights. You may file a complaint with us by contacting
the Privacy Officer.
You also may file a complaint with the Secretary of the U.S.
Department of Health and Human Services. You may submit this
complaint to:
Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
We will not penalize or in any other way retaliate against you
for filing a complaint.
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