HEALTH PLAN
NOTICE 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.
We respect the confidentiality of your health information and will protect it in
a responsible and professional manner. The Health Insurance Portability and
Accountability Act of 1996 (HIPAA) requires us to protect the privacy of
Protected Health Information (Your Information) and to send you this notice.
This notice applies to the Health Plans provided by the Affiliated Covered
Entity defined below. It describes how we may use and share Your Information to
carry out payment and health care operations. And, it describes how we may use
and share Your Information for other purposes that are permitted or required by
law. In the event uses or disclosures of Your Information described in this
notice are prohibited or materially limited by other applicable law in your
state we will comply with that more stringent law.
We abide by the terms of this notice. If we materially change the terms of this
notice we will mail you a copy of the revised notice if you are then covered by
one of our Health Plans. Copies of our current notice may be obtained by
contacting us at the telephone number or address below, or may be found on our
Web site at www.bankersconseco.com.
It is not necessary for you to take any action as a result of this notice unless
you wish to exercise one or more of your rights as explained under the
Rights That You Have section.
HOW WE USE OR SHARE YOUR INFORMATION
The following are different ways that we use and share Your Information:
Your Authorization
Except as described below, we will not use or share Your Information unless you
have signed a form telling us we can. You may revoke your authorization, in
writing, but not for any information that we have already relied on. Nor may
you revoke your authorization if signing it was a condition of obtaining
insurance and we have the right, under other law, to contest a claim under the
policy.
Use and Share for Payment
We may request, use, and share Your Information as necessary to help pay your
medical bills that have been submitted to us. As one example, we may use
information regarding your medical procedures and treatment to process and pay
claims.
Use and Share for Health Care Operations
We may use and share Your Information with others who help us conduct our
business operations. Examples of business operations might be, underwriting
your policy, reinsurance, compliance, auditing, and other functions related to
your Health Plan. We will not share Your Information with outside groups unless
they agree to keep it protected.
Family and Friends Involved in Your Care
We may share Your Information with your family, friends, and others who are
involved in your care or payment of a claim unless you can and do object. If we
determine that a limited disclosure is in your best interest, we may share Your
Information with such individuals, even if you are incapacitated or not
available. For example, we may use our professional judgment to disclose
information to your spouse concerning the processing of a claim. If you do not
wish us to share Your Information with your spouse or others, you may exercise
your right to request a restriction on our disclosures of Your Information (see
below).
Other Products and Services
We may contact you to provide information about other health-related products
and services that may be of interest to you. For example, we may contact you
about our health insurance products that could enhance or substitute for
existing Health Plan coverage, and about health-related products and services
that may add value to your Health Plan.
Other Uses and Disclosures -
Unless otherwise prohibited by law, we may, under certain circumstances, as
described below make other uses and disclosures of Your Information without
your authorization.
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We may use or disclose Your Information for any purpose required by law. For
example, to respond to a court order.
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We may disclose Your Information for public health activities, such as
reporting of disease, injury, birth and death, and for public health
investigations.
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We may disclose Your Information to the proper authorities if we suspect child
abuse or neglect; we may also disclose Your Information if we believe you to be
a victim of abuse, neglect, or domestic violence.
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We may disclose Your Information if authorized by law to a government oversight
agency (e.g., a state insurance department) conducting investigations, or civil
or criminal proceedings.
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We may disclose Your Information in the course of a judicial or administrative
proceeding (e.g., to respond to a subpoena or discovery request).
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We may disclose Your Information to the proper authorities for law enforcement
purposes.
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We may disclose Your Information to coroners, medical examiners, and/or funeral
directors consistent with law.
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We may use or disclose Your Information for cadaveric organ, eye or tissue
donation.
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We may use or disclose Your Information for research purposes, but only as
permitted by law.
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We may use or disclose Your Information to avert a serious threat to health or
safety.
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We may use or disclose Your Information if you are a member of the military as
required by armed forces services, and we may also disclose Your Information
for other specialized government functions such as national security or
intelligence activities.
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We may disclose Your Information to workers' compensation agencies for your
workers' compensation benefit determination.
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We will, if required by law, release Your Information to the Secretary of the
Department of Health and Human Services for enforcement of HIPAA.
RIGHTS THAT YOU HAVE
Access to Your Information
You have the right to inspect and obtain a copy of certain information that we
maintain about you in your Designated Record Set. Your request must be in
writing and signed by you. We may charge you a fee for copying and postage. You
may request access request forms from us at the address below.
Amendments to Your Information
You have the right to request that Your Information be amended or corrected. We
will give each request careful consideration but we are not required to amend
Your Information. Your amendment request must be in writing, must be signed by
you, and must state the reasons for the request. You may ask for amendment
request forms from us at the address below.
Accounting for Disclosures of Your Information
You have the right to receive an accounting of certain disclosures of Your
Information made by us during the six years prior to your request. Please note
that we are not required to provide you with an accounting of the following
information:
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Any information collected prior to April 14, 2003;
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Information disclosed or used for treatment, payment, and health care
operations purposes;
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Information disclosed to you or pursuant to your authorization;
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Information that is incident to a use or disclosure otherwise permitted;
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Information disclosed for a facility's directory or to persons involved in your
care or other notification purposes;
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Information disclosed for national security or intelligence purposes;
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Information disclosed to correctional institutions, law enforcement officials
or health oversight agencies;
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Information that was disclosed or used as part of a limited data set for
research, public health, or health care operations purposes.
To be considered, your accounting requests must be in writing and signed by you.
You may ask for accounting request forms from us at the address below. The
first accounting in any 12-month period is free; however, we may charge you a
fee for each subsequent accounting you request within the same 12-month period.
Restrictions on Use and Disclosure of Your Information
You have the right to ask us to restrict how we use or disclose Your
Information for insurance payment or health care operations purposes, or to
family members and others who are involved in your health care or payment for
your health care. We are not required to agree to your request but will attempt
to honor reasonable requests.
We retain the right to terminate an agreed-to restriction if we believe it is
appropriate. If we terminate the restriction we will notify you of such
termination. You also have the right to terminate, in writing, any agreed-to
restriction. You may request a restriction (or termination of an existing
restriction) by contacting us at the address below.
Request for Confidential Communications
You have the right to ask to receive confidential communications regarding Your
Information. For example, if you think that you would be harmed if we left you
a message on voice mail or sent information to a particular address, you can
ask us to send the information by alternate means such as by fax or to an
alternate address. Requests for confidential communications must be in writing,
signed by you, and sent to us at the address below.
Right to a Paper Copy of the Notice
You have the right to a paper copy of this notice upon request by contacting us
at the telephone number or address below.
Complaints
If you believe your privacy rights have been violated, you can file a complaint
with us in writing at the address below. You may also file a complaint in
writing with the Secretary of the U.S. Department of Health and Human Services
in Washington, D.C., within 180 days of a violation of your rights. Filing a
complaint will not negatively impact your status as an insured or the services
you receive from us.
Personal Representative
We will treat your personal representative as you, except where prohibited by
law.
DEFINITIONS
Affiliated Covered Entity (ACE) means, for purposes
of this Notice, the Health Plans issued by certain companies that are under
common ownership1.
Designated Record Set means the information maintained
and used by us to make decisions about you.
Health Plan means, for purposes of this Notice, the
following health related products: major medical, basic medical, long term
care, short-term care, Medicare supplement, vision, dental, specified disease
(e.g., cancer), hospital indemnity, intensive care, and other coverages that
meet the definition of Health Plan contained in HIPAA. The following products
are not considered Health Plans: coverage only for accident, or disability
income insurance, or any combination thereof, life insurance, annuities and
other coverages that do not meet the definition of Health Plan contained in
HIPAA.
Protected Health Information (Your Information) means
information about you that we have collected and maintain and that identifies
you, or reasonably could identify you, and that relates to:
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your past, present, or future physical or mental health or condition;
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the provision of health care to you; or
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the past, present, or future payment for the provision of health care to you.
Protected Health Information includes that of persons living or dead.
FOR FURTHER INFORMATION
If you have questions or need further assistance regarding this Notice, you may
contact our Privacy Office by writing to:
Bankers Conseco Life Insurance Company
Privacy Office
600 West Chicago Ave
Chicago, Illinois 60654-2800
Telephone: 1-866-385-7252
EFFECTIVE DATE
This Notice is effective November 20, 2006.
1Affiliated Covered Entity:
Bankers Life and Casualty Company, Bankers Conseco Life Insurance Company,
Colonial Penn Life Insurance Company, Conseco Insurance Company, Conseco Health
Insurance Company, Conseco Life Insurance Company, Conseco Senior Health
Insurance Company, Washington National Insurance Company
Policyholders
click here
for questions and answers about the Notice of Privacy Practices
and HIPAA.
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