This program is administered
by the Managed Risk Medical Insurance Board (MRMIB).
PCIP 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.
The Privacy Of Health Information
Each individual's health information is protected under a federal law called the Health Insurance Portability and Accountability Act (HIPAA) and under state laws when they are stricter than HIPAA. These laws require the PCIP to keep protected health information private except under certain circumstances, and to provide this Notice of our legal duties and privacy practices we use to protect health information.
How HIPAA Defines Protected Health Information
The law defines protected health information as individually identifiable health information that is created, received, sent or maintained by us. It is information that identifies an individual in some way and relates to his or her past, present or future payment of that individual's health care.
How We May Use and Disclose Information
The law permits the PCIP to use and disclose an individual's protected health information to ensure that he or she receives treatment, in order to pay the program's share of treatment costs, and for health care operations. The examples below show how we may use and share health information for these purposes.
The PCIP may use an individual's protected health information to ensure that an individual enrolled in the Program receives medical treatment or services. For example, a provider, such as a doctor or hospital, might check to see if that individual is actually enrolled in the PCIP. When you enroll in the PCIP we share that enrollment information with providers so they can verify that you are eligible to receive treatment under the Plan.
The PCIP may use and disclose an individual's protected health information to others for purposes of making payment for treatment and services that those individuals receive. For example, on a monthly basis, we pay for services you receive under the Plan. When we pay the providers, we give them a list that identifies the individuals for whom we are paying. To make sure we have paid correctly, we may obtain a record of your protected health information from the company that pays the claims for us (our third party administrator) to make sure our records are in agreement.
For health care operations:
The PCIP may use and disclose protected health information for operational purposes. For example, we may share the protected health information of individuals enrolled in the Program with others who evaluate our Programs for us through consumer surveys. We may also use this information to help us determine eligibility, conduct audits, process appeals, and for general administration of the program.
The PCIP may use the protected health information you provide to us to contact you about health-related benefits and services that may be of interest to you.
Other Uses And Disclosures Without Written Permission
The PCIP is required to share an individual's protected health information with the United States Secretary of Health and Human Services in connection with an investigation to determine our compliance with the law. In addition, the PCIP may make uses and disclosures of your protected health information without your written permission as follows:
As required or permitted by law:
The PCIP may use and disclose information about an individual as required or permitted by law. For example, we may use and disclose information about an individual for the following purposes:
- In the course of any judicial or administrative proceeding in response to a subpoena or pursuant to an order of the court or an administrative law judge,
- To report information related to abuse or neglect, and
- For a law enforcement purpose to a law enforcement official.
An individual's protected health information may be used or disclosed for public health activities such as assisting public health authorities or persons to prevent or control disease or injury.
Health and Safety:
An individual's protected health information may be used or disclosed to prevent a serious threat to the health or safety of a person or the public.
Individuals Who Have Died:
Protected health information about individuals who have died may be disclosed to funeral directors or coroners to enable them to carry out their duties.
The PCIP may disclose protected health information to a health oversight agency for oversight activities authorized by law such as determining compliance with program standards.
Specialized Government Functions:
The PCIP may disclose protected health information for specialized government functions. For example, the PCIP may share protected health information with other government agencies, relating to an individual's eligibility in the PCIP program.
The PCIP may use or disclose an individual's health information for research purposes when an institutional review board or privacy board has reviewed the research proposal and established procedures to ensure the privacy of health information and has approved the research.
Benefit Programs for Work-Related Injuries:
The PCIP may disclose protected health information to the extent necessary to comply with the laws relating to workers' compensation or other similar programs that provide benefits for work-related injuries or illness without regard to fault.
Other Disclosures May Be Made With Written Permission
The PCIP will not make any other disclosures of your protected health information unless you have given written permission. You have the right to take back your permission in writing at a later time in order to stop any future disclosures.
Your Privacy Rights
Right to Request Restrictions on Disclosures:
You have the right to request restrictions on certain uses and disclosures of protected health information; however the PCIP is not required to agree to those requested restrictions. These requests may have to do with the use or disclosure of protected health information to carry out treatment, payment or health care operations, or with disclosure of the information to a family member, other relative, close personal friend, or other person identified by you, when the information is important to that person's involvement with your care or payment related to care. These requests may also have to do with the use or disclosure of protected health information to notify or help notify a family member, personal representative or other person responsible for your care of your location, general condition or death (either directly or in coordination with authorized entities assisting in disaster relief efforts).
If the PCIP does agree to a restriction, the restriction can later be terminated by you in writing, by agreement between you and the PCIP in writing or orally, or by the PCIP for health information created or received after you are notified that the restriction has been removed. The PCIP may also disclose health information about you if you are in need of emergency treatment, even if the PCIP has agreed to a restriction.
Right to Request Confidential Communications:
You have the right to request in writing that the PCIP make contact only in writing or at a different address, post office box, or telephone number. Your request must include the alternative address or other method of contact and, if appropriate, information on how payment, if any, will be made. We will honor reasonable requests if you say it is necessary to protect your safety.
Right of Access to Protected Health Information:
You have the right to look at and get a copy of protected health information that the PCIP has about you. You must make the request in writing. We may charge you a small amount for copies to cover our costs. We may deny your request for reasons allowed by law, but if we do, our denial may be reviewed under certain circumstances. If your request involves protected health information that the PCIP does not maintain but knows where it is maintained, you will be told where to direct your request.
Right to Request that Protected Health Information be Corrected:
You have the right to request in writing that information in our records be changed if it is not correct or complete. You must provide in your request a reason to support the requested change. We may refuse this request if we did not create or keep the information, if the information is not available for inspection (such as information compiled to be used in a civil, criminal or administrative proceeding), or if the information is correct and complete. You may request a review of our refusal and you may send in a statement disagreeing with our decision. The PCIP will keep this statement with your records.
Right to Receive Information about our Disclosures:
When we share protected health information about you for reasons other than treatment, payment, or health care operations (and certain other reasons stated in the law), you have the right to request a list of the parties we shared the information with, and to ask of when, for what reasons, and what information was shared.
Right to Receive a Paper Copy of this Notice on Request:
You have a right to receive a paper copy of our Notice of Privacy Practices at any time upon request, even if you have agreed to receive the Notice electronically.
The PCIP must obey the terms of this Notice of Privacy Practices. However, we have the right to make a change in our privacy practices and apply it to all records in our possession. If we do make changes, we will revise this Notice and send it promptly to the Subscriber who is then enrolled in the PCIP.
How To Exercise Your Privacy Rights
If you would like more information about how to exercise the privacy rights explained in this Notice, or have the questions about this Notice and want further information, please call or write us at:
Managed Risk Medical Insurance Board
P.O. Box 2769
Sacramento, CA 95812-2769
Please Note: The PCIP does not have complete copies of your medical records. If you want to look at, get a copy of, or change your medical records, please contact your doctor, provider, or PCIP customer service.
How To File A Complaint
If you believe your privacy rights are violated after April 14, 2003, and you wish to complain, you may file a complaint in writing with our Privacy Officer at the address above, or you may contact the Regional Manager of the United States Department of Health and Human Services at the address and phone numbers below:
Secretary of the U.S. Department of Health and Human Services
Attn: Regional Manager
Office for Civil Rights
90 7th Street, Suite 4-100
San Francisco, CA 94103
(415) 437-8310 Phone
(415) 437-8329 FAX
(415) 437-8311 TTY/TDD
For additional information, call:
U.S. Office for Civil Rights at 1-866-OCR-PRIV (1-866-627-7748), or
The PCIP will not take away your health care benefits or retaliate against you in any way if you choose to file a complaint or use any of the privacy rights in this Notice.