FY2011 Health Benefits Booklet

Maryland State Employees and Retirees 65
Health Insurance
Portability and
Accountability Act (HIPAA)
Certificates of Coverage and the Health Insurance
Portability and Accountability Act of 1996 (HIPAA)
A Federal law, HIPAA, requires employers to provide
certificates of coverage to all former Employees, who then
can give the certificates to their new employers. If you or
your dependents obtain new employment, you may request
a certificate of coverage from the State, which describes the
length and types of benefits coverage (e.g., medical, dental, etc.)
you and your dependents had under the State Program. You
may request a HIPAA Certificate of Coverage by writing to the
Department of Budget and Management (DBM), Employee
Benefits Division, at the address on the inside front cover of this
guide. The medical plans offered through the State will mail
one to you automatically when your coverage with them ends.
Notice of Privacy Practices and HIPAA Authorization
Form
The State conforms to the Federal HIPAA regulations and
State regulations on the privacy of your health information.
The Notice of Privacy Practices describes the privacy practices
of the State Employee and Retiree Health and Welfare Benefits
Program.
HIPAA and State regulations require your written
authorization to disclose certain health information to
other people. If your written authorization is needed,
you may use the HIPAA authorization form to provide
the needed authorization that is located on our website,
www.dbm.maryland.gov. Assigned HIPAA authorization
remains in effect, unless you change or revoke the
authorization.
Notice of Privacy Practices – State Employee and
Retiree Health and Welfare Benefits Program
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.
Under Federal and State law, DBM administers the State
Employee and Retiree Health and Welfare Benefits Program
(the Program) and protects the privacy of your protected
health information. DBM takes steps to ensure that your
protected health information is kept secure and confidential
and is used only when necessary to administer the Program.
DBM is required to give you this notice to tell you how DBM
and your Healthcare Flexible Spending Account (HCFSA) may
use and give out (“disclose”) your protected health information
held by DBM and your HCFSA. This information generally
comes to DBM when you enroll in the Program and from
your plan administrator as part of administration of the health
plan. This information comes to your HCFSA when you
submit requests for reimbursement. This Notice also describes
how your HCFSA uses and discloses your personal health
information. DBM and the HCFSA abide by the terms of this
Notice.
Your health plan in the Program (for example, the CareFirst
BlueCross BlueShield PPO) will also protect, use, and disclose
your personal health information. For questions about your
health information held by your health plan, please contact
your health plan directly. The plans in the Program all follow
the same general rules that DBM and the HCFSA follows to
protect, use, and disclose your protected health information.
Each plan will use and disclose your protected health
information for payment purposes, for treatment purposes, and
for administration purposes.
DBM has the right to use and disclose your protected health
information to administer the Program. For example, DBM
will use and disclose your protected health information:
u To communicate with your Program health plan when you
or someone you have authorized to act on your
behalf asks for our assistance regarding a benefit or
customer service issue. DBM may need a written
authorization from you for your health plan to discuss
your case.
u To determine your eligibility for benefits and to
administer your enrollment in your chosen health plan.
u For payment related purposes, such as to pay claims for
services provided to you by doctors, hospitals,
pharmacies, and others for services delivered to you
that are covered by your health plan, to coordinate your
benefits with other benefit plans (including Workers’
Compensation plans or Medicare) to reimburse you from
your HCFSA, or to make premium payments.
u To collect payment from you when necessary, such as
copayments, premiums or other contributions.
u For treatment related purposes, such as to review, make a
decision about, or litigate any disputed or denied claims.
u For health care operations, such as to conduct audits of
your health plan’s quality and claims payments, to
procure health benefits offered through this Program,
to set premiums, and to investigate potential fraudulent
claims. However, note that federal law prohibits the use
and disclosure of genetic information about an individual,
including for underwriting purposes. The group health
plan benefits options and the HCFSA offered through the
Program do not use genetic information for underwriting
(or for any other) purposes.
DBM and/or your HCFSA will also use and disclose your
protected health information:
u
u
u
u
To you or someone who has the legal right to act
for you (your personal representative). To authorize
someone other than you to discuss your protected
health information, please contact DBM to complete an
authorization form.
To law enforcement officials when investigating and/or
processing alleged or ongoing civil or criminal actions.
Where required by law, such as to the Secretary of the
U.S. Department of Health and Human Services, to the
Office of Legislative Audits, or in response to a
subpoena.
For health care oversight activities (such as mandatory
reporting, and fraud and abuse investigations).
IMPORTANT Notices
and Information