THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND SHARED. IT WILL ALSO TELL YOU HOW YOU CAN GET THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The law says we must keep your health information private. This Notice will tell you what information we collect. It also will tell you how we use it. You can call our Member Services Department at 414 223-4847 if you have questions about this Notice. If you do not have any questions, you do not have to do anything.
There are instances when the law allows us to use and share your health information without your written consent. The following is a list of those times.
1. For Treatment
We may use your health information to provide you with health care treatment or services. We also use it to arrange social services you may need. For example:
2. For Payment Functions
We may use your health information to pay for services you had or to manage benefits. For example:
3. For Health Care Operations
Your health information may be used or shared to carry out benefit or service related activities. This means that your health information may be shared with our staff or others to:
4. For Appointments and Treatment Choices
Your health information may be used or shared to remind you of appointments. It may also be used to tell you about different ways you can be treated. Or, it can be used to tell you about other health and services that you might like.
5. To Family and Personal Representatives
We may share your health information with a relative, close personal friend or other person who is involved in your care.
6. Business Associates
We work with others outside of iCare to provide certain services. These others are called business associates. Your health information may be disclosed to them so they can do the job we ask them to do. They must also protect your health care information. For example, we work with a company to pay your claims.
7. As Required by Law
Your health information may be used or shared as required by any federal, state or local law. This means that we may share information when:
8. Health Oversight Actions
Your health information may be given to state or federal agencies to do reviews or to check on our licensure. This helps the government to see what we are doing to meet civil rights or other laws.
9. For Law Enforcement
Your health information may be shared if the law says we must. We will also share it if there is a valid court order to help identify or find suspects, persons hiding from the law or missing persons.
10. For Serious Threats to Health or Safety
Your health information may be shared in order to prevent or lessen a serious threat to your health or safety. It may also be shared if there is a threat to the health and safety of the public.
11. For the Country’s Safety
Your health information may be shared for the safety of the country. It may also be shared for government benefit reasons.
12. To Jails or Prisons
We may need to share your health information with jail or prison staff if you become an inmate.
13. For Research
Your health information may be used for research needs, but only after steps are taken to protect your privacy. We will ask for your permission if the researcher asks for information that says who you are or if the researcher will be giving you care.
14. For Worker’s Compensation or Social Security Reviews
Your health information may be shared as needed to follow the laws related to worker’s compensation. It may also be shared to help decide if you can get social security benefits.
15. Coroners, Medical Examiners or Funeral Directors
Health information may be shared to help confirm the identity of a deceased person.
16. Organ Donations
Information may be given to agencies if you need an organ transplant. It may also be shared with agencies if you want to donate an organ.
17. Other Uses
At times we may need to use or share your health information for other reasons. Other uses and disclosures not described in this Notice will be done only with your consent. You may cancel your consent, but it must be done in writing. When you cancel your consent, we will no longer be able to use or share your health information as stated in the consent. But, we will not be able to take back any use or sharing that was already made with your consent. You will be told as soon as possible after the information is shared.
18. Uses That Require an Authorization by You
There are certain uses and disclosures that require your written consent. These uses include:
All questions about your rights must be in writing. You can send your written request to Member Advocate/Member Rights Specialist, Independent Care Health Plan, 1555 N. RiverCenter Drive, Suite 206, Milwaukee, WI. 53212. You can also call our Member Advocate/Member Rights Specialist to help make your request at 414 223-4847.
have the right to change the terms of this Notice at any time. The new Notice will be effective for all health information we have. Any changes to the Notice will be mailed to you at the address you gave us. It will also be posted to our website. Until changes are made to the Notice, we will comply with this version.
You may complain to us if you believe your privacy rights have been violated. Complaints must be in writing. If you need help filing a complaint, contact our Member Advocate/Member Rights Specialist at 414 223-4847. You will not be treated any differently if you file a complaint.
You may also file a complaint with the Secretary of the Department of Health and Human Services by writing to Office of Civil Rights, Department of Health and Human Services, 200 Independence Ave. SW, Washington, D.C. 20201.
If you have any questions or complaints, please contact us at: 414-223-4847
Toll Free 1-800-777-4376
TTY 1-800-947-3529 or 711
Voice 1-800-947-6444 or 711
April 15, 2019
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