Notice of Privacy Practices of Freelancers Insurance Company
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.
In order to provide you with the benefits to which you are entitled, Freelancers Insurance Company ("FIC") must collect, create and maintain health information about you. FIC is required by law to maintain the privacy of this information. This Notice of Privacy Practices describes how FIC uses and discloses your health information, and explains certain rights you have regarding this information. FIC is required by law to provide you with this Notice and we will comply with its terms during the period when it is effective.
Which Information We Protect
We protect any information that identifies you or could be used to identify you that relates to your health, your treatment or your health insurance benefits. We refer to this information as "protected health information". Your name, address and other basic identifying information constitutes protected health information even if unaccompanied by information about your health, treatment or benefits.
How FIC Uses and Discloses Your Health Information
The following is a list of the ways in which FIC may use and disclose your protected health information. We will use and disclose your protected health information only for one of the purposes on this list. In certain cases we provide examples of the types of uses or disclosures that fall within a particular category. These examples are intended to help you understand what these categories mean; they do not cover every type of use or disclosure within each category. Please note that, as described below, special rules apply to our disclosure of certain sensitive health information.
1. Uses and Disclosures for Treatment, Payment and Health Care Operations.
FIC may use or disclose your protected health information without your written authorization for any of the following purposes:
a. Treatment. We may use and disclose your protected health information to facilitate treatment by health care providers. For example, we may disclose information about services you received from one health care provider to another health care provider who is treating you.
b. Payment. We may use and disclose your protected health information for our own payment purposes and to assist in the payment activities of other health plans and health care providers. Our payment activities include determining your eligibility for benefits and providing reimbursement for health care services.
c. Health Care Operations. We may use and disclose your protected health information to carry out health care operations, which includes quality improvement activities, evaluating our own performance and resolving any complaints or grievances you may have. For example, we may collect and review records maintained by doctors and hospitals that have treated you to see whether they have provided you with appropriate treatment. We may also use and disclose your protected health information to assist other health plans and health care providers in performing certain health care operations, such as quality assessment and improvement, reviewing the competence and qualifications of health care providers and conducting fraud detection or compliance.
d. Appointment Reminders. We may use and disclose your protected health information to remind you about appointments you have made to receive health care services or to encourage you to make such appointments.
e. Treatment Alternatives. We may use and disclose your protected health information to tell you about treatment alternatives or other health-related benefits and services that may be of interest to you.
2. Uses and Disclosures For Public Need Purposes.
FIC may use and disclose your protected health information without your written authorization for the following purposes:
a. As required by law. We may use and disclose your protected health information as required by state, federal or local law.
b. For public health activities. We may disclose your protected health information to public health authorities or other agencies and organizations conducting public health activities, such as preventing or controlling disease, injury or disability and reporting births, deaths, child abuse or neglect, domestic violence, potential problems with products regulated by the Food and Drug Administration or communicable diseases.
c. About victims of abuse, neglect or domestic violence. We may disclose your protected health information to an appropriate government agency if we believe you are a victim of abuse, neglect or domestic violence and you agree to the disclosure or the disclosure is required or permitted by law. We will let you know if we disclose your information for this purpose unless we believe that letting you know would place you at risk of serious harm or we believe that a person who usually receives information from us on your behalf is responsible for the abuse, neglect or domestic violence.
d. For health oversight activities. We may disclose your protected health information to health oversight agencies for oversight activities authorized by law such as audits, investigations, inspections and licensing surveys.
e. For judicial and administrative proceedings. We may disclose your protected health information in the course of any judicial or administrative proceeding in response to an appropriate order of a court or administrative body. We may also disclose information in response to a subpoena or discovery request if certain safeguards are in place.
f. For law enforcement purposes. We may disclose your protected health information to a law enforcement official for a legitimate law enforcement purpose such as: identifying or locating a suspect, fugitive or missing person; complying with a court order, subpoena or administrative request; providing information about a victim of a crime or reporting a death that may be the result of a crime.
g. About deceased individuals. We may disclose your protected health information to a coroner or medical examiner for purposes such as identifying a deceased person or determining a cause of death. We may also disclose information to a funeral director as necessary to assist such a person in carrying out his or her duties.
h. For organ, eye or tissue donations. We may disclose your protected health information to organ procurement organizations and similar entities for the purpose of assisting them in organ, eye or tissue donation or transplantation activities.
i. For research. We may use or disclose your protected health information for research purposes, such as studies comparing the benefits of alternative treatments received by our members. We will use or disclose your information for research purposes only with the approval of our privacy board, which must follow a special approval process. Before permitting any use or disclosure of information for research purposes, our privacy board will balance the needs of the researchers and the potential value of their research against the protection of your privacy.
j. To avert a serious threat to health or safety. We may use or disclose your protected health information to prevent or lessen a serious and immediate threat to your health or safety or to the health or safety of another person or the general public. We will disclose your information for this purpose only to someone who may be able to prevent or lessen this type of threat.
k. For specialized government functions. We may use or disclose your protected health information to provide assistance for certain types of government activities. If you are a member of the armed forces of the United States or a foreign country, we may disclose your information to appropriate military authorities as they deem necessary to carry out military missions. We may also disclose your information to federal officials for lawful intelligence or national security activities and for the purpose of providing protective services to the President of the United States and other officials. In addition, if you are in the custody of a correctional institution or law enforcement official, we may disclose your information to that institution or official for certain purposes.
l. Workers' compensation. We may use or disclose your protected health information as permitted by the laws governing the workers' compensation program or similar programs that provide benefits for work-related injuries or illnesses.
3. Disclosures to Family Members and Friends.
We may disclose your protected health information to a family member, other relative or close personal friend assisting you in receiving or obtaining payment for health care services. We will disclose your information to these individuals only if you tell us to do this or if we advise you that we will do so and you do not object. We may also disclose your health information to disaster relief organizations such as the Red Cross to assist your family members or friends in locating you or learning about your general condition in the event of a disaster.
4. Obtaining Your Authorization for Other Uses and Disclosures.
FIC will not use or disclose your protected health information for any purpose not specified in this Notice of Privacy Practices unless we obtain your written authorization. If you give us your authorization, you may revoke it at any time, in which case we will no longer use or disclose your health information for the purpose you authorized, except to the extent we have relied on your authorization in providing benefits. We will not refuse to enroll or continue to provide benefits to you if you decide not to sign an authorization form.
5. Special Treatment of Sensitive Health Information.
Certain sensitive health information provided to us by health care providers is subject to special restrictions on re-disclosure under state or federal laws or regulations. We will not re-disclose HIV/AIDS-related information, records of federally assisted alcohol or drug abuse treatment facilities or programs, or records of licensed mental health facilities or programs except as permitted by such laws or regulations. In addition, we will not use or disclose genetic testing data except as permitted by applicable state and federal law.
Your Rights Regarding Your Health Information
You have the following rights regarding your protected health information:
1. Right to Inspect and Copy.
You have the right to inspect or request a copy of your protected health information that we may use in making decisions about your benefits. Your request should describe the information you want to review and the format in which you want to review it; for example, whether you want to inspect your records at our offices, receive paper copies or get the information on a computer diskette. We may refuse to allow you to inspect or obtain copies of this information in certain limited cases. We may charge you a reasonable fee for copies to cover our costs. You may ask to inspect or obtain copies of your information by contacting FIC customer service.
2. Right to Request Amendments.
You have the right to request changes to any of your protected health information if you state a reason why this information is incorrect or incomplete. We do not have to agree to make the changes you request. If we do not believe the changes you requested are appropriate, we will notify you in writing how you can have your objection to our decision included in our records. You may request changes to your information by contacting FIC customer service.
3. Right to an Accounting of Disclosures.
You have the right to receive a list of disclosures of your protected health information that have been made by FIC. The list will not include disclosures made for certain types of purposes, such as disclosures for treatment, payment or health care operations or disclosures you authorized in writing. Your request should specify the time period for which you want this list, which can be no longer than six years and may not include dates prior to April 14, 2003. The first time you ask for a list of disclosures in any 12-month period, we will provide it for free. If you request additional lists during a 12-month period, we may charge you a fee to cover our costs in providing the additional lists. You may request a list of disclosures by contacting FIC customer service.
4. Right to Request Restrictions.
You have the right to request restrictions on the ways in which we use and disclose your protected health information for treatment, payment and health care operations, or disclose this information to disaster relief organizations or individuals who are involved in your care. We do not have to agree to the restrictions you request. You may request a restriction on the use or disclosure of your information by contacting FIC customer service.
5. Right to Request Confidential Communications.
You have the right to ask us to send protected health information to you in a different way or at a different location if you believe that you may be endangered by our ordinary form of communication. For example, if you are afraid that someone living with you may open mail we send you and harm you as a result, you can ask us to send your mail to a relative's or employer's address. You must state in your request that you believe you will be endangered by our ordinary form of communication but you do not have to explain why you believe this is the case. Your request should also specify where and/or how we should contact you. We will accommodate all reasonable requests. You may ask us to send information to you in a different way or at a different location by contacting FIC customer service.
6. Right to Paper Copy of Notice.
You have the right to receive a paper copy of this Notice of Privacy Practices at any time. You may receive a paper copy even if you have previously requested to receive this Notice electronically. You may obtain a paper copy of this Notice, by contacting FIC customer service. You may also print out a copy of this Notice for your records.
If you believe your privacy rights have been violated, you may file a complaint with FIC or the Secretary of the U.S. Department of Health and Human Services. You may file a complaint with FIC by contacting FIC customer service. You will not be penalized or retaliated against by FIC for filing a complaint.
Changes to this Notice
FIC may change the terms of this Notice of Privacy Practices at any time. If we change the terms of this Notice, the new terms will apply to all of your health information, whether created or received by FIC before or after the date on which the Notice is changed. We will notify you of changes to this Notice by mailing you a copy of the new Notice within 60 days of the date on which it becomes effective.
If you have any questions or would like additional information about this Notice or FIC’s privacy practices, please contact FIC customer service.
This Notice of Privacy Practices is effective as of January 1, 2009.
Freelancers Insurance Company Gramm-Leach-Bliley Privacy Notice
We respect the confidentiality of our customers’ personal information. We are required by federal and state laws to maintain the privacy of this information and to send you this notice. This notice explains how we use your personal financial information and when we can share that information with others. It also informs you about your rights with respect to your personal financial information and how you can exercise these rights. Our policy applies to both current and former customers and members.
Collection of Information
We may collect non-public, personal financial information about you from the following sources:
- Information we receive from you on applications or other forms, such as name, address, social security number, date of birth, gender, or marital status;
- Information about your transactions with us, our affiliates, or others; and
- Information we receive from consumer reporting agencies.
Disclosure of Information
We do not disclose any non-public, personal information about our current and former customers to anyone except as permitted by law. For example, we may share information to affiliates and other third parties that perform claims processing, utilization review and other services on our behalf; or to provide information to insurance regulators or law enforcement authorities upon request.
If we take part in an activity that would require us to give you a chance to opt-out, we will contact you. We will let you know how to tell us that you do not want us to use or share your nonpublic personal financial information for that activity.
We restrict access to the non-public, personal financial information of our customers and members to those employees who need to know that information to perform their job responsibilities. We maintain physical, electronic, and procedural safeguards that comply with federal and state regulations to guard your non-public, personal financial information.
Copies and Changes
You have the right to receive a paper copy of this notice upon request at any time. You can also view a copy of this notice on our Web site at www.FreelancersInsuranceCo.com. We may change these policies, standards at procedures at any time and we will notify you of any material changes.
If you think we have not protected your privacy, you can file a complaint with us. We will not take action against you for filing a complaint.
If you have any questions or would like further information about this notice or about how we use or share information, please contact us at 800.707.8802. You can also direct questions to FIC customer service.