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.
To be successful, Geisinger Health Plan* ("GHP") must uphold the trust of our members and those with whom we interact. This trust, in turn, is built on honoring our commitment to respect your privacy. GHP has a policy that assures the confidentiality of your protected health information (PHI). PHI is any individually identifiable health information that is created or received by GHP that relates to your past, present or future physical or mental health or condition; the provision of health care to you; or the past, present, or future payment for the provision of health care to you.
GHP is required to provide you this notice about its legal duties and privacy practices, and must follow the privacy practices described in this notice while it is in effect.
Uses and Disclosures of Health Information
GHP uses and discloses PHI in connection with your treatment, to make payment for your health care and for GHP's health care operations. Except as stated below, GHP will not use or disclose your PHI unless you have signed a form that allows GHP to do so.
Treatment: GHP may disclose your PHI to doctors, dentists, pharmacies, hospitals and other caregivers who request it in connection with your treatment. GHP may also disclose your protected health information to health care providers in connection with preventive health, early detection and disease and case management programs.
Payment: GHP will use and disclose your PHI to administer your health benefits policy or contract. This may involve verifying eligibility, claims payment, subrogation, utilization review and management, medical necessity review, care coordination, and responding to complaints, appeals and external requests.
Health Care Operations: GHP will use and disclose your PHI as necessary, and as permitted by law, for its health care operations. These health care operations include, but are not limited to, credentialing health care providers, peer review, business management, accreditation and licensing, utilization review and management, quality improvement and assurance, enrollment, rating and underwriting, reinsurance, compliance, auditing and other functions related to your health benefits plan.
Business Associates: Certain aspects and components of GHP's services are performed through contracts with outside persons or organizations, such as identification card printing, subrogation, accreditation, etc. At times it may be necessary for GHP to provide PHI to one or more of these outside persons or organizations who assist GHP with health care operations. GHP will give out as little information as possible to allow our business associates to complete these tasks and GHP requires these business associates to appropriately safeguard the privacy of your information.
Family and Friends Involved In Your Care: With your approval, GHP may disclose your PHI to designated family, friends, and others involved in your care. You may designate another person to act on your behalf in signing forms or making decisions when you are unable to do so. GHP recognizes the following documentation for member representation in certain circumstances:
- Applicable Durable Power of Attorney
- Legal Guardian
- A GHP "Authorized Representative Form"
If a member wishes to designate an authorized representative, he or she must complete and sign an Authorized Representative form. This form can be obtained by calling the Customer Service Team at the telephone number indicated on the back of the member identification card.
If you are unavailable, incapacitated or facing an emergency medical situation and GHP determines that a limited disclosure may be in your best interest, GHP may share limited PHI with such individuals without your authorization.
Special authorizations are required by Pennsylvania laws to permit disclosures of certain highly sensitive personal information. In certain situations, consistent with applicable regulations or laws, GHP will ask for your written authorization before using or disclosing identifiable health information about you. If you sign an authorization to disclose specific information, you can later revoke that authorization to stop future uses and disclosures.
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Additional Uses and Disclosures of Health Information
GHP may also contact its members to provide appointment reminders, information about treatment alternatives, or other health-related benefits and services available to its members. Members may also be contacted by GHP regarding fund-raising activities of GHP or those of its parent company, Geisinger Health System Foundation. Also, GHP may use or disclose your PHI in the following situations without an authorization:
- GHP may release your PHI for any purpose required by law;
- GHP may release your PHI for public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations;
- GHP may release your PHI as required by law if we suspect child abuse or neglect; we may also release your PHI as required by law if we believe you to be a victim of abuse, neglect, or domestic violence;
- GHP may release your PHI to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
- GHP may release your PHI to your plan sponsor (employer), provided, however, your plan sponsor must certify that the information provided will be maintained in a confidential manner and not used for employment related decisions or for other employee benefit determinations or in any other manner not permitted by law;
- GHP may release your PHI if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
- GHP may release your PHI if required to do so by a court or administrative ordered subpoena or discovery request; in most cases you will have notice of such release;
- GHP may release your PHI to law enforcement officials as required by law to report wounds and injuries and crimes;
- GHP may release your PHI to coroners and/or funeral directors consistent with law;
- GHP may release your PHI if necessary to arrange an organ or tissue donation from you or a transplant for you;
- GHP may release your PHI for certain research purposes when such research is approved by an institutional review board with established rules to ensure privacy;
- GHP may release your PHI if you are a member of the military as required by armed forces services; we may also release your PHI if necessary for national security or intelligence activities; and
- GHP may release your PHI to workers' compensation agencies if necessary for your workers' compensation benefit determination.
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Individual Member Rights Regarding Privacy
The Health Insurance Portability and Accountability Act (HIPAA) provides specific rights to all individuals about their PHI. You may request in writing that GHP not use or disclose your PHI for payment, health management or other health care operational purposes except when specifically authorized by you, when required by law, or in emergency circumstances. GHP will consider your request but GHP is not legally required to accept it. To find out more about any of the following rights or request the necessary form(s), call the Customer Service Team at the telephone number indicated on the back of your member identification card or contact the Designated Privacy Officer as noted in the Contacts section of this notice.
Communications that you receive from GHP containing your health information will be conveyed in a confidential manner. You have the right to request in writing and GHP will process reasonable requests by you to receive communications regarding your protected health information from us by alternative means or at alternative locations.
Unless GHP is given an alternative address, GHP will mail explanation of benefit forms and other mailings containing protected health information to the address that GHP has on record for the subscriber.
In most cases, you have the right to look at or get a copy of your PHI in a designated record set. Generally a "designated record set" contains 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. If you request copies, GHP may charge reasonable copying and postage fees.
You may also request a copy of your protected health information in electronic format or direct us to transmit it to another entity or individual you choose.
If you believe that information in your GHP records is incorrect or incomplete, you have the right to request in writing that GHP correct or add to the existing information. GHP is not obligated to make all requested corrections but will give careful consideration to each request. Requests for amendment(s) must be in writing, signed by you or your representative, and must state the reasons for the request. If GHP makes a correction that you request, GHP may also notify others who work with us and have copies of the uncorrected record if GHP believes that the notification is necessary.
You also have the right to receive a list of instances after April 14, 2003 where GHP has disclosed PHI about you for reasons other than claims payment or related administrative purposes. If you request this accounting more than once in a 12-month period, GHP may charge you a reasonable fee.
We are required to notify you, should certain unpermitted uses and disclosures (a "breach") occur, that may cause you financial, reputational, or other significant harm. This will be done by mail and other means if necessary.
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GHP's Duties
GHP is required by law to maintain the privacy of your PHI, provide this notice about its information practices and follow the information practices that are described in this notice. GHP may change its policies at any time. If GHP makes a significant change in its policies, GHP will provide notice of the change to you via a letter, newsletter notice or a revised Subscription Certificate. You may request a copy of GHP's Privacy & Confidentiality policy on uses and disclosures of health information at any time. For more information on GHP's privacy practices, please contact the person listed below.
GHP has procedures in place to prevent unauthorized access to your PHI, which include employee training in the importance of maintaining member confidentiality and privacy.
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Complaints
If you are concerned that GHP has violated your privacy rights or you disagree with a decision GHP has made about access to your GHP records, please follow the complaint procedures described in your plan documents. You can also call the Customer Service Team or contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request. Individuals will not be retaliated against for filing a complaint with either GHP or the U.S. Department of Health and Human Services.
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Contacts
If you have any questions or need additional information, please contact your Customer Service Team at the telephone number indicated on the back of your member identification card or GHP's Designated Privacy Officer as follows:
Designated Privacy Officer
Geisinger Health Plan
100 N. Academy Avenue
Danville, PA 17822-8005
Telephone: 570-271-7360
E-mail: systemprivacyoffice@geisinger.edu
Effective Date
This notice went into effect April 14, 2003, in accordance with the privacy regulations of the Health Insurance Portability and Accountability Act. The notice was most recently revised in February 2010.
Footnote
* The below-listed separate corporate entities are among those that are participating in an Organized Health Care Arrangement:
Geisinger Health Plan
Geisinger Indemnity Insurance Company
Geisinger Quality Options Inc.
Geisinger Clinic (all sites)
Geisinger System Services
Geisinger Medical Center
Geisinger Assurance Company, Ltd.
Geisinger Wyoming Valley Medical Center
Geisinger Medical Management Corporation
Geisinger Community Health Services
Marworth
International Shared Services, Inc.
Geisinger Insurance Corporation-Risk Retention Group
The legally separate corporate parent, Geisinger Health System Foundation, is also participating in such organized health care arrangement. These separate legal entities may share protected health information with each other as necessary to carry out treatment, payment or health care operations relating to the organized health care arrangement unless otherwise limited by law, rule or regulation. Unless we provide you with a different Notice of Privacy Practices and except as provided above, this Notice of Privacy Practices will apply to all entities that we may purchase or affiliate with in the future.
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