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University of Detroit Mercy Group Health Plans Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

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Introduction

University of Detroit Mercy is the plan sponsor of a variety of medical benefits programs. For the purposes of this Notice, we refer to these health benefit programs collectively as the “UDM Health Benefit Plan”.

For example, the UDM Health Benefit Plan includes health, and prescription drug benefits offered through the Group Health Plan. In most cases, these programs are administered through arrangements with health insurance companies, HMOs, and third party administrators. The UDM Health Benefit Plan does not include workers compensation, life insurance, disability benefits, medical leaves, pre-employment physicals, on-site medical services or drug testing.

The UDM Health Benefit Plan is subject to a federal law called the Health Insurance Portability and Accountability Act of 1996, also known as “HIPAA”. HIPAA sets standards to protect the privacy of health information. The Plan is required by HIPAA to:

Our Pledge Regarding Health Information

The UDM Health Benefit Plan is committed to protecting health information about you. This Notice describes the UDM Health Benefit Plan’s privacy practices and that of all its employees and staff. This Notice will tell you about the ways in which we may use and disclose health information about you. The Notice also describe your rights and certain obligations we have regarding the use and disclosure of health information.

In addition to HIPAA, the UDM Health Benefit Plan uses and discloses health information in compliance with all other applicable state and federal laws.

How We May Use and Disclose Health Information About You

The following categories describe different ways that the UDM Health Benefit Plan uses and discloses health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

The UDM Health Benefit Plan has delegated some plan administration activities to its plan sponsor and its Business Associates, such as third party administrators, who also may use and disclose your health information to perform services and functions on behalf of the UDM Health Benefit Plan.

For Treatment. The UDM Health Benefit Plan may use and disclose health information about for medical treatment or services. For example, if your health care needs to be coordinated, we may give health information about you to your primary care physician or specialist.

For Payment. The UDM Health Benefit Plan may use and disclose health information about you so that the treatment and services you receive may be billed and payment may be made to the health care providers that provided care to you. For example, we may need to give your health information to a third party administrator so that they will pay claims for your care.

For Health Care Operations. The UDM Health Benefit Plan may use and disclose health information about you for UDM Health Benefit Plan operations. These uses and disclosures are necessary to run the UDM Health Benefit Plan and make sure that our members receive quality services. For example, we may use health information and disclose it to the plan sponsor to review benefit coverage options.

Treatment Alternatives. The UDM Health Benefit Plan may use and disclose health information about you to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-Related Benefits and Services. The UDM Health Benefit Plan may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care. The UDM Health Benefit Plan may disclose health information about you to a close personal friend or family member who is involved in your health care or payment for your care if you have signed an authorization. Please note that our health insurance companies, HMOs and third party administrators may impose different protections when disclosing health information to individuals involved in your care or payment for your care.

For Special Purposes. The UDM Health Benefit Plan may disclose health information about you for special purposes as permitted or required by law, including the following:

Other Uses and Disclosures of Your Health Information

Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us an authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health information about you for the reasons covered by the written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provide to you.

Your Rights Regarding Health Information About You

You have many rights with regard to your health information. If you wish to exercise any of these rights, please submit your request in writing to: UDM Health Benefit Plan Privacy Officer

Your Right to Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your care. We may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request.

Your Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to add a statement. You must provide a reason that supports your request for an amendment.

Your Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of certain disclosures we made of health information about you. Your request must state a time period. We may limit the time period to 6 years and to disclosures made on or after April 14, 2004. The first list you request within a 12-month period is free. For additional lists, we may charge you for the costs of providing the list.

Your Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you. We are not required by law to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

Your Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. We will accommodate all reasonable requests supported by a statement from you that you would be in danger without the confidential communication.

Right to Paper Copy of this Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. You may also obtain a copy of this Notice at www.udmercy.edu/hr.

Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with the UDM Health Benefit Plan. You may also file a compliant directly with the Secretary of the Department of Health and Human Services. You will not be penalized in any way for filing a complaint.

Changes to This Notice

The UDM Health Benefit Plan reserves the right to change this Notice. The UDM Health Benefit Plan reserves the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future.