HERITAGE VISION PLANS, INC.
NOTICE OF PRIVACY PRACTICES
Heritage Vision Plans, Inc. is required by law to safeguard and protect the privacy and security of its members' "Protected Health Information (PHI)" as defined by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Protected Health Information includes information relating to a member's past, present, or future health condition, the provision of health care services to a member, or the payment for such health care. Such information may include, but is not limited to, a member's: name, Social Security Number or Member ID Number, dates of service, diagnosis or claim information. Such information does not include proprietary information of Heritage Vision Plans.
We are required by law to provide this Notice of Privacy Practices to you as a Heritage Vision Plans member, which includes our legal obligations and your rights concerning Protected Health Information.
Heritage Vision Plans reserves the right to amend this Notice of Privacy Practices at any time as permitted by law. We reserve the right to change our privacy practices and to make provisions effective for all Protected Health Information we maintain. Changes to our privacy practices will be made available on our web site within sixty (60) days, and will be provided to members upon request.
Uses and Disclosure of Protected Health Information
Heritage Vision Plans protects your Protected Health Information from inappropriate use and disclosure.
We will not use or disclose your Protected Health Information without your authorization except for the following reasons that are permitted or required by law.
1. For Business Operations. We may use and disclose Protected Health Information for business operations, including: rating the risk related to the vision plan and determining premiums for the plan; administering your vision benefit plan; conducting audits and reviewing compliance; processing claims; and reviewing utilization. We may also disclose Protected Health Information to business associates who provide a business service to us related to the above-listed business operations and who sign a Business Associates Agreement to maintain the security and privacy of Protected Health Information as required by law.
2. For Payment. We may use and disclose Protected Health Information to pay participating providers for services provided to you under your vision benefit plan. This includes determination of eligibility, verification of services provided, medical necessity for certain benefits, and if applicable, coordination of benefits. We may also disclose limited Protected Health Information to your Health Plan Administrator for billing-related purposes or for audit and review.
3. For Treatment. We may use and disclose Protected Health Information to an optometrist, ophthalmologist, or optician providing treatment or materials to you.
4. For Health Oversight. We may use and disclose Protected Health Information to health oversight agencies such as a governmental agency or regulator with health oversight responsibilities.
5. For Public Health. We may use and disclose Protected Health Information for public health activities as required by a public health agency to avert a serious health threat or report disease outbreaks.
6. For Law Enforcement. We may use and disclose Protected Health Information in response to a request by a law enforcement official/agency made through a warrant, subpoena, court order or similar legal means.
7. For Other Government Purposes. We may use and disclose Protected Health Information for other governmental purposes, including: judicial or administrative purposes; national intelligence and security activities; workers compensation purposes; or reporting to the armed services.
Your Health Information Rights
1. Request to Restrict PHI. You have the right to request that we restrict the use and disclosure or your Protected Health Information, with some exceptions as may be required by law. Heritage is not required to agree to the request.
2. Review/Amend Your PHI. You have the right to review and obtain copies of your Protected Health Information. Requests for copies must be submitted to Heritage in writing. You have the right to request that we amend your health information if you believe such information is incorrect or incomplete. If we deny your request, you may have a statement added to your health information.
3. Disclosure Accounting. You have the right to receive an accounting of disclosures of your Protected Health Information made by us other than for payment, treatment, or health care operations purposes. In the event confidentiality of such disclosure is requested by a governmental or law enforcement agency, you may not have the right to receive disclosure of such information.
4. Confidential Communication. You have the right to request that we communicate with you regarding your Protected Health Information by alternative means or at an alternative location to your home address. Such requests must be made in writing to Heritage.
5. Paper Copy. You have the right to receive a paper copy of this notice.
6. Heritage Contact Information. If you have any questions regarding this notice or to exercise any of the rights contained herein, contact us at 1-800-252-2053, or by mail at:
Heritage Vision Plans, Inc.
440 E. Congress, Suite 300
Detroit, MI 48226
ATTN: HIPAA Compliance Dept.
7. Complaints. You may submit a complaint to Heritage Vision Plans by mail:
Heritage Vision Plans, Inc.
440 E. Congress, Suite 300
Detroit, MI 48226
ATTN: HIPAA Compliance Dept.
You may also submit a complaint to the U.S. Secretary of Health and Human Services. We will not take action against you for filing a complaint.
