Notices of Privacy Practices

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.
 
If you have questions about any part of this Notice, complaints about our privacy practices, or want more information about our privacy practices, call Customer Service at (877) 230-7555 or contact us at the following address:

Prevea360 Health Plan
Privacy Officer
1277 Deming Way
Madison, WI 53717

Protecting the Privacy of Your Personal Health Information
We are required by law to maintain the privacy of your personal health and financial information (collectively referred to as "nonpublic personal information") and provide you with written notification of our legal duties and privacy practices concerning that information. This Notice describes how we protect the confidentiality of our members' (and former members') nonpublic personal information. It includes brief explanations on how we obtain, use, and protect your nonpublic personal information.

What Types of Nonpublic Personal Information Do We Collect About You?
We collect a variety of nonpublic personal information needed to administer health insurance coverage and benefits. We collect this information about you from some of the following sources:
  • Information we receive directly or indirectly from your applications, surveys, and other forms, in writing, in person, by telephone, and electronically. Examples include name, address, social security number, date of birth, marital status, and medical history.
  • Information about your transactions with us, our affiliates, our providers, our agents, and others. This includes information from health care claims, medical history, eligibility information, payment information, service requests, and appeal and grievance information.
  • Information you authorize us to collect from others.

Choices About Your Health Information
We will not use or disclose your health information without your written authorization, except as described in this Notice. You generally have the right and choice to tell us to:
  • Share information with your family, close friends, or others involved in payment for your care.
  • Share information in a disaster relief situation.
In the following cases we never share your information unless you give us written permission:
  • Most uses and disclosures of psychotherapy notes.
  • Marketing purposes.
  • Sale of your information.
If you do give us written authorization to use or disclose your health information for a particular purpose, you may change your mind at any time. You must let us know in writing if you change your mind.

How We May Use or Disclose Your Health Information
We will not disclose your nonpublic personal information unless we are allowed or required by law to do so. The following categories describe the ways that we may use and disclose your nonpublic personal information. For each category of uses and disclosures, we will explain what we mean and present some examples. Not every use or disclosure we might make will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.
 
Note: Some of the uses and disclosures described in this notice may be limited in certain cases by applicable State laws that are more stringent than Federal laws, including disclosures related to mental health and substance abuse, developmental disability, alcohol and other drug abuse (AODA), and HIV testing.
 
We are allowed to use and disclose information that falls within one of the following categories:
 
1. Payment. We may use and disclose your health information to make and collect payment for treatment and services you receive, such as: determining your eligibility for plan benefits, obtaining premiums, determining your health plan's responsibility for benefits, and collecting payment for your health services.

2. Health Care Operations. We may use and disclose your health information to support our business activities and improve our coverage and services. Health care operations include such activities as: Underwriting, premium rating, and other functions related to plan coverage. However, we are not allowed to use genetic information to decide whether we will give you coverage or the price of that coverage.
  • Quality assessment and improvement activities.
  • Activities designed to improve health and reduce health care cost.
  • Case management and care coordination.
  • Accreditation, certification, licensing, and credentialing activities.
  • Reviews and auditing, including fraud and abuse detection programs, medical reviews, legal services, audit services, and compliance programs.
  • Submitting claims for stop-loss coverage.
  • Business planning, management, and general administrative activities, including customer service and resolution of grievances.
Notice: We are part of an Organized Health Care Arrangement (OHCA) with SSM Health and Dean
Health System. As part of the OHCA, we may from time to time share your information with other
members of the OHCA in order to perform joint health care operations. These uses and disclosures
allow the OHCA to run efficiently. For example, we may share your information in order to: improve
population health management; conduct quality assessment and improvement activities; conduct or
arrange for medical review, legal services, audit services, and fraud and abuse detection programs;
business planning and development such as cost management; and business management and general
OHCA administrative activities.
 
3. Treatment. We may disclose your health information to a physician or other health care provider that is treating you. We may contact you with information on treatment alternatives and other related functions that may be of interest to you.
 
4. Distributing Health-Related Benefits and Services. We may use and disclose your health information to provide information on health-related benefits and services that may be of interest to you.
 
5. Disclosure to Plan Sponsors. If applicable, we may disclose your health information to the sponsor of your group health plan for purposes of administering benefits under the plan. If you have a group health plan, your employer is the plan sponsor.
 
6. Public Safety. We can share health information about you for certain situations such as: preventing disease; helping with product recalls; reporting adverse reactions to medications; reporting suspected abuse, neglect, or domestic violence; and preventing or reducing a serious and imminent threat to the health or safety of a particular person or the public.
 
7. Research. Under certain circumstances, and only after a special approval process, we may use and disclose your health information to help conduct research.
 
8. Required by Law. We will share information about you if laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
 
9. Workers’ Compensation, Law Enforcement, and Other Government Requests. We can use and share health information about you: for workers’ compensation claims; for law enforcement purposes or with a law enforcement official; with health oversight agencies for activities authorized by law; and for special government functions such as military, national security, and presidential protective services.
 
10. Legal Actions. We may disclose your health information in the course of any administrative or judicial proceeding.

How Do We Protect This Information?
We limit the collection of nonpublic personal information to that which is necessary to administer our business, provide quality service, and meet regulatory requirements.
 
We maintain physical, electronic, and procedural safeguards that comply with federal regulations to safeguard your nonpublic personal information. We limit the internal use of oral, written, and electronic nonpublic personal information about you and ensure that only authorized staff and business associates with the need to know have access to it. We maintain safeguards for your nonpublic personal information and review them regularly to protect your privacy.

Opting Out of Information Sharing or Gathering
From time to time, you may have received notices from other entities that provide you an opportunity to "opt out" of certain disclosures. The most common type of "opt out"disclosure is the disclosure of personal information to a non-affiliated company that would allow that company to market its products or services to you. Many federal and state laws that we must comply with prohibit us from making these types of disclosures. Because we do not make these types of disclosures, it is not necessary for you to complete an "opt out" form or take any action to restrict such disclosures.

Your Health Information Rights
  1. Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your health information. However, Prevea360 is generally not required to agree to the restrictions that you request. You must make your request in writing to our Privacy Officer at the address included in the beginning of this Notice, or contact the Customer Service Department for a copy of our "Request for Restrictions on Use/Disclosure of PHI" form. We will let you know if we can grant your request or not.
  2. Right to Request Confidential Communications. You have the right to receive your health information through a reasonable alternative means or at an alternative location. For example, you may ask that we only communicate with you at a certain telephone number or by mail if you feel the disclosure of your health information through normal means could endanger you. You must make your request in writing to our Privacy Officer at the address included in the beginning of this Notice, or contact the Customer Service Department for a copy of our "Request for Confidential Communications" form to complete. We will try to honor requests but are not always required to. 
  3. Right to See and Copy. You have the right to see and copy certain health information about you. You must make your request in writing to our Privacy Officer at the address included in the beginning of this Notice, or contact the Customer Service Department for a copy of our "Request for Access to Personal Health Information" form to complete. If you request a copy of the information, we may charge you a reasonable cost-based fee.
  4. Right to Correct Records. You have a right to request that we correct certain health information held by Prevea360 if you think it is incorrect or incomplete. We may deny your request, but if we do we will provide you with a reason why. You must make your request, including the reason for your request, in writing to our Privacy Officer at the address included in the beginning of this Notice, or contact the Customer Service Department for a copy of our “Request to Amend Health Information” form to complete.
  5. Right to Accounting of Disclosures. You have the right to receive a list or “accounting of disclosures” of your health information made by us in the past six years. The list will not include disclosures made for purposes of treatment, payment, health care operations, or certain other disclosures (such as those you asked us to make). You must make your request in writing to our Privacy Officer at the address included in the beginning of this Notice, or contact the Customer Service Department for a copy of our “Request for Access to Personal Health Information” form to complete. We will provide one accounting a year at no charge, but we may charge you a fee for subsequent accounting requests.
  6. Right to Copy. You have a right to receive an electronic or paper copy of this Notice at any time. To get a paper copy of this Notice, send your written request to our Customer Service Department at 1277 Deming Way, Madison, WI 53717. You may also get a copy of this Notice on our website, www.prevea360.com.
  7. Right to be Notified of a Breach. You will be notified in the event of a breach of your unsecured protected health information.
If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact our Privacy Officer at the address included in the beginning of this Notice or contact the Customer Service Department.

Changes to this Notice of Privacy Practices
We may amend this Notice from time to time and make the new provisions effective for all nonpublic personal information we maintain, including information we created or received before the change. We will always comply with the current version of this Notice.

Complaints
Please submit complaints about this Notice or how we handle your health information, in writing, to our Privacy Officer. We will not hold any complaint you submit against you in any way. In addition, if you believe your privacy rights have been violated, you may file a complaint with the Secretary of the U.S. Department of Health and Human Services.
 
The effective date of this Notice is September 23, 2013.
 
Questions?
If you would like more information about our privacy practices please call the Prevea360 Health Plan Customer Care Center at 877.230.7555.