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Privacy Statements>HIPAA Privacy Notice
Effective Date: July 1, 2004
CIGNA HealthCare
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.
CIGNA HealthCare* is committed to maintaining and protecting the confi dentiality of our members’ personal information.
We are required by federal and state law to protect the privacy of your personal health information and other
personal information about you. In this Notice, we will refer to this information as “confidential information.” We
also are required to send you this Notice about our policies, safeguards and practices. When we use or disclose your
confidential information, we are bound by the terms of this Notice or our revised notice, if we revise it.
How We Protect Your Privacy
CIGNA HealthCare locations that maintain confidential
information have procedures for accessing, labeling and
storing confidential records. Access to our facilities is limited
to authorized personnel. We restrict internal access to
your confidential information to CIGNA HealthCare employees
who need to know that inform-ation to conduct
our business. CIGNA HealthCare trains its employees on
policies and procedures designed to protect your privacy.
Our Privacy Offi ce monitors how we follow those policies
and procedures and educates our organization on this
important topic.
To provide you with health insurance benefi ts, CIGNA
HealthCare receives confidential information from
you and from other sources such as your health care
providers, insurers and your employer. The information
we receive includes personal health information
as well as your name and address. CIGNA HealthCare
will not disclose confi dential information without your
authori-zation unless it is necessary to provide your
health benefi ts, administer your benefi t plan, to support
CIGNA HealthCare programs or services, or as otherwise
required or permitted by law. When we need to disclose
your confi dential information, we will follow the policies
described in this Notice to protect your privacy.
How We Use and Disclose Your Confidential Information
We will not use your confi dential information or disclose
it to others without your authorization, except for the
following purposes:
Treatment
We may disclose your confi dential information
to your doctors, hospitals and other health care providers for their provision, coordination or
management of your health care and related services – for example, for coordinating your health care with
us or for referring you to another provider for care.
Payment
We may use and disclose your confidential
information to obtain payment of premiums for your
coverage and to determine and fulfi ll our responsibility
to provide your health plan benefi ts – for example,
to make coverage determinations, administer claims
and coordinate benefi ts with other coverage you may
have. We also may disclose your confi dential information
to another health plan or a health care provider
for its payment activities – for example, for the other
health plan to determine your eligibility or coverage,
or for the health care provider to obtain payment for
health care services provided to you.
Health Care Operations
We may use and disclose your
confi dential information for our health care operations – for example, to provide customer service and conduct
quality assessment and improvement activities. Other health operations may include providing appointment
reminders or sending you information about HealthCare
treatment alternatives or other health-related benefits
and services. We also may disclose your confi dential
information to another health plan or a provider who
has a relationship with you, so that it can conduct
quality assessment and improvement activities – for
example, to perform case management.
Disclosure to Persons Involved in Your Care.
We
may disclose confi dential information about you or
your child to persons who are involved in your or your
child’s care or payment for that care. For example, we
might disclose confi dential information about you to
your spouse or confi dential information about your
child to your former spouse who is the parent of your
child. We will disclose only the infor-mation that is
relevant to the care or payment. Callers will be asked
to provide identifying information and, if they are asking
about a claim, they will have to show knowledge of
that claim before we will answer their questions. You
have the right to stop or limit this kind of disclosure
by requesting a restriction on the disclosure of your
confidential information as described below under“Right to Request Additional Restrictions.”
¦ Disclosures to your Employer as Sponsor of Your
Health Plan. We may disclose your confi dential information
to your employer or to a company acting
on your employer’s behalf, so that it can monitor,
audit and otherwise administer the employee health
benefit plan in which you participate. Your employer
is not permitted to use the confi dential information
we disclose for any purpose other than administration
of your health benefi t plan. See your employer’s health
benefit plan documents for information on whether
your employer receives confi dential information and
the identity of the employees who are authorized to
receive your confi dential information.
¦ Disclosures to CIGNA HealthCare Vendors and
Accreditation Organizations.
We may disclose your
confidential information to companies with whom we
contract if they need it to perform the services we’ve
requested — for example, vendors who help us provide
important information and guidance to members with
chronic conditions like diabetes and asthma. CIGNA
HealthCare also discloses confi dential information
to accreditation organizations such as the National
Committee for Quality Assurance (NCQA) when the
NCQA auditors collect Health Plan Employ-er Data
and Information Set (HEDIS®)** data for quality measurement
purposes. When we enter into these types
of arrangements, we obtain a written agree-ment to
protect your confi dential information.¦ Promotional Gifts. We may use your confi dential information
or disclose it to a mailing vendor so that we
may provide you with a promotional gift of nomi-nal
value such as a pen or a calendar. We will not disclose
your confi dential information to other com-panies for
their marketing purposes.
Public Health Activities
We may disclose your confidential information for the following public health
activities and purposes:
(1) to report health information
to public health authorities that are authorized
by law to receive such information for the purpose of
preventing or controlling disease, injury or disability;
(2) to report child abuse or neglect to a government authority that is authorized by law to receive such
reports;
(3) to report information about a product or
activity that is regulated by the U.S. Food and Drug
Administration (FDA) to a person respon-sible for
the quality, safety or effectiveness of the product or
activity; and
(4) to alert a person who may have been
exposed to a communicable disease, if we are authorized
by law to give this notice.
Health Oversight Activities
We may disclose your
confi dential information to a government agency
that is legally responsible for oversight of the health
care system or for ensuring compliance with the rules
of government benefi t programs, such as Medicare
or Medicaid, or other regulatory programs that need
health information to determine compliance.
¦ For Research. Under very limited circumstances, your
confidential information may be used and disclosed
for research without an authorization – for example,
an authorization would not be necessary if your name,
street address and other identifying information were
removed.
To Comply with the Law
We may use and disclose
your confidential information to comply with the
law.
Judicial and Administrative Proceedings
We may
disclose your confi dential information in a judicial
or administrative proceeding or in response to a legal
order.
Law Enforcement Officials
We may disclose your
confidential information to the police or other law
enforcement offi cials, as required by law or in com-pliance
with a court order or other processes authorized
by law.
Health or Safety
We may disclose your confi dential
information to prevent or lessen a serious and im-minent
threat to your health or safety or the health and
safety of the general public.
Government Functions
We may disclose your confidential information to the U.S. military or to authorized
federal offi cials for purposes specified by federal
law.
– 2 –
** “HEDIS” is a registered trademark of the National Committee for Quality Assurance (NCQA).
– 3 –
¦ Workers’ Compensation. We may disclose your confidential information when necessary to comply with
workers’ compensation laws.
Please note that should your coverage with CIGNA HealthCare terminate, we will continue to protect your confi
dential information. It will be used and disclosed only for
the purposes described above and in accordance with the
policies and procedures described in this Notice.
Uses and Disclosures With Your Written Authorization
We will not use or disclose your confi dential information
for any purpose other than the purposes described in this
Notice without your written authorization. For example,
we will not supply confi dential information to another
company for its marketing purposes or to a potential
employer with whom you are seeking employ-ment
without your signed authorization. You may revoke an
authorization that you previously have given by sending
a written request to our Privacy Offi ce, but not with
respect to any actions we already have taken.
CIGNA HealthCare complies with state laws that place
further restrictions on the disclosure of your personal
health information without your authorization. For
example, many states have laws that do not permit us to
disclose a diagnosis of AIDS or mental illness. These laws
have some limited exceptions.
Your Individual Rights
Right to Request Additional Restrictions
You may
request restrictions on our use and disclosure of your
confidential information for the treatment, payment
and health care operations purposes explained in
this Notice. While we will consider all requests for
restrictions carefully, we are not required to agree to
a requested restriction.
Right to Receive Confidential Communications
You may ask to receive communications of your confidential information from us by alternative means of
communication or at alternative locations. While we
will consider reasonable requests carefully, we are not
required to agree to all requests.
Right to Inspect and Copy your Confi dential Information
You may ask to inspect or to obtain a copy
of your confidential information that is included in
certain records we maintain. Under limited circumstances,
we may deny you access to all or a portion
of your records. If you request copies, we may charge
you copying and mailing costs.
Right to Amend your Records
You have the right
to ask us to amend your confi dential information
that is contained in certain records we maintain. If
we determine that the record is inaccurate, and the
law permits us to amend it, we will correct it. If your
doctor or another person created the information that
you want to change, you should ask that person to
amend the information.
Right to Receive an Accounting of Disclosures
Upon request, you may obtain an accounting of disclosures
we have made of your confi dential information.
The accounting that we provide will not include
disclosures made before April 14, 2003, disclosures
made for treatment, payment or health care operations,
disclosures made earlier than six years before
the date of your request, and certain other disclosures
that are excepted by law. If you request an accounting
more than once during any 12-month period, we will
charge you a reasonable fee for each accounting statement
after the first one.
Right to Receive Paper Copy of this Notice
You may
call Member Services at the toll-free number on your
ID card to obtain a paper copy of this Notice, even if
you previously agreed to receive this Notice electronically.
If you wish to make any of the requests listed above
under “Individual Rights,” you must complete and
mail us the appropriate form. To obtain forms please
call Member Services at the toll-free number on your
ID card to request the appropriate form. Completed
forms should be mailed to the address printed on the
forms. After we receive your signed, completed form,
we will respond to your request. For More Information or Complaints.
If you want more information about your privacy rights, do not understand your privacy rights, are concerned that we have violated your privacy rights or disagree with a decision that we made about access to your confi -dential information, you may contact our Privacy Offi ce. You may also fi le written complaints with the Secretary of the U.S. Department of Health and Human Services. Please call our Privacy Offi ce to obtain the correct address for the Secretary. We will not take any action against you if you fi le a complaint with the Secretary or us.
You may contact our Privacy Office at:
Privacy Offi ce
PO Box 55270
Phoenix, AZ 85078-5270
Telephone Number: 602-956-4200
Fax Number: 602-328-4035
We may change the terms of this Notice at any time.
If we change this Notice, we may make the new notice
terms effective for all of your confi dential information
that we maintain, including any information we created
or received before we issued the new notice. If we change
this Notice, we will send you the new notice if you are
enrolled in a CIGNA HealthCare benefi t plan at that time.
In addition, we will post any new notice on our Web site
at http://www.cigna.com/general/misc/privacy.html.
You also may obtain any new notice by calling Member
Services at the toll-free number on your ID card.
You may contact our Privacy Office by calling 602-956-4200 or writing to Attn: Privacy Office, CIGNA HealthCare, P.O. Box 55270, Phoenix, AZ 85078-5270