Lynchburg City Schools

HIPAA

Health Insurance Portability and Accountability Act

Lynchburg City Schools Health Plan and All Other Lynchburg City Schools Welfare Benefit Plans Notice of Privacy Practices.

This notice is in effect as of April 1, 2004

Statement of Our Duties

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, with whom that information may be shared and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of the benefit plan except when the release is required or authorized by law or regulation.

We reserve the right to change the terms of this notice and to make any new provision effective to all of the personal and protected health information that we maintain about you. If we revise this notice, we will provide you with a revised notice by mail or electronically.

Statement of Your Rights

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, with whom that information may be shared and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of the benefit plan except when the release is required or authorized by law or regulation.

We reserve the right to change the terms of this notice and to make any new provision effective to all of the personal and protected health information that we maintain about you. If we revise this notice, we will provide you with a revised notice by mail or electronically.

• The right to request that we place additional restrictions on our uses and disclosures of your personal health information. However, we are not obligated to agree to impose any such additional restrictions.
• The right to access, inspect and copy the protected information pertaining to you that we maintain in our files about you, and the right to have us correct or amend any information that we create in error. Requests to access or amend your health information should be sent to the contact person and address provided in paragraph 8.
• The right to receive an accounting of the disclosures of your personal health information that we make for purposes other than activities related to your treatment, or our payment functions or other health care operations.
• The right to request that you receive communications of personal health information in a confidential manner.
• If you receive this notice electronically, you have the right to obtain a paper copy of this notice from us on request. Please direct your request to the department for personnel.

Information We Collect About You

We collect the following categories of information about you from the following sources:

• Information that we obtain directly from you, in conversations or on applications or other forms that you fill out.
• Information that we obtain as a result of our transactions with you.
• Information that we obtain from your medical records or from medical professionals.
• Information that we obtain from other entities, such as health care providers or other insurance companies, in order to service your policy or carry out other insurance-related or health plan needs.

Permissible Uses and Disclosures of Protected Health Information

• To Carry Out Treatment Functions. We may use or disclose your health information without your permission for health care providers to provide you with treatment.
• To Carry Out Payment Functions. We may use or disclose your health information without your permission to carry out activities relating to reimbursing you for the provision of health care, obtaining premiums, determining coverage, and providing benefits under the health and/or welfare benefit plan. Such functions may include reviewing health care services with respect to medical necessity; coverage under the policy, appropriateness of care of justification of charges.
• To Carry Out Certain Operations Relating to Your Benefit Plan. We also may use or disclose your protected health information without your permission to carry out certain limited activities relating to your health benefits, including reviewing the competence or qualifications of health care professionals, conducting quality assessment activities, amending, replacing or adding benefits, and placing contracts for stop-loss insurance or reinsurance. For example, the plan may use information about your claims to refer you to a disease management program, project future benefit costs or audit the accuracy of the claims processing functions.
• To Plan Sponsors pursuant to the restrictions imposed on the plan sponsors in the plan documents. (See Plan Document and Summary Plan Description pages 87-89).
• In Situations Permitted Or Required By Law. We also may use or disclose your protected health information without your written permission for other purposes permitted or required by law, including the following:
  • As authorized by and to the extent necessary to comply with workers compensation or other no fault laws.
  • To a health oversight agency for activities including audits or civil, criminal or administrative proceedings.
  • To a public health authority for purposes of public health activities. For example, to the Food and Drug Administration to report consumer product defects.
  • To a law enforcement official for law enforcement purposes or in response to a court order or in the course of any judicial or administrative proceeding.
  • To organ procurement organizations, or to other entities for approved research purposes.
  • To a government authority, including a social service or protective services agency, authorized to receive reports of abuse, neglect or domestic violence.
  • For Any Purposes To Which You Have Not Objected. In certain limited circumstances, we may use or disclose your protected health information after we have given you an opportunity to object and you have not objected. For example, if you do not object, we may use limited information about you to notify family members or any other person identified by you in emergency circumstances.
  • For Purposes For Which We Have Obtained Your Permission. All other uses or disclosures of your protected health information will be made only with your written permission, and any permission that you give us may be revoked by you at any time.

Complaints About Misuse of Health Information

You may complain either directly to us or to the U.S. Department of Health and Human Services, 200 Independence Ave., S.W., Washington,D.C. 20201, 1-877-696-6775, if you believe that your rights with respect to our protection of your health information have been violated. To file a complaint with us submit your complaint in writing, including as many details, such as names and dates, as possible to the Director for Personnel, Lynchburg City Schools, 915 Court Street, P O Box 1599, Lynchburg, VA 24505. You will not be retaliated against in any way for filing a complaint.

Our Practices Regarding Confidentiality and Security

We restrict access to non-public personal information about you to those employees who need to know that information in order to provide products or services to you. We maintain physical and procedural safeguards that comply with federal regulations to guard your non-public personal information.

Our Policy Regarding Dispute Resolution

Any controversy or claim arising out of or relating to our privacy policy, or the breach thereof, shall be settled by arbitration in accordance with the rules of the American Arbitration Association and judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof.

Contact Person for Filing a Complaint or Obtaining Further Information

You may contact Lynchburg City Schools Privacy Officer, the Director for Personnel, for further information about the complaint process, or for further explanation of this document.