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Pratt Regional Medical Center
September 23, 2013

Our Commitment to Protecting Your Privacy


You do not need to respond to this notice in any way.

Our Responsibilities and Privacy Commitment
We understand the importance of protecting your private information. Our highest priority is to maintain your trust and confidence. We will maintain our commitment to safeguarding your information now and in the future.

We are required by law to:

  • Maintain the privacy of your personal information.
  • Provide you with certain rights with respect to your personal information.
  • Provide you with a copy of this Notice of our legal duties and privacy practices with respect to your personal information.
  • Follow the terms of the Notice that is currently in effect.

We are guided by our respect for the confidentiality of your personal information. We are providing you with this notice in accordance with privacy laws and because we want you to know that we value your privacy.

Information We Collect
Personal Information is any information we obtain about you in the course of issuing insurance and/or providing services. The information we may obtain includes, but is not limited to, your past, present, or future physical or mental health or condition, the
provision of health care to you, payment for the provision of health care to you, your Social Security number, employment history, credit history, income information, and bank or credit card information.

We obtain this information from several sources, including but not limited to applications or other forms you complete, your business dealings with us and other companies, and consumer reporting agencies.

Our Privacy and Security Procedures
Our employees who have access to this information are those who must have it to provide products or services to you. Below are some examples of our guidelines for protecting information.

  • Paper copies, when used, are viewed, discussed, and retained in private surroundings.
  • Individuals viewing information stored in a computer must have passwords to gain access. Passwords are provided only to individuals who must have access to provide products or services to our insureds.
  • Our business associates use information only for the purpose provided. Business associates sign a contract agreeing to follow our privacy procedures.

Information We Disclose
We will not disclose any Personal Information about you, except as allowed by law, including the Fair Credit Reporting Act. We may share all of the information we collect with insurance companies, agents, companies that help us to conduct our insurance business, companies that are self-insured, or others as permitted by law. Below are examples of the times we may share information for business purposes.

  • Underwriting (but not Personal Information that consists of the genetic information of an individual);
  • Premium rating;
  • Submitting claims;
  • Reinsuring risk;
  • Assessing quality;
  • Business management and planning; and
  • Sales, transfer, merger or consolidation of the business.

Your information may also be shared:

  • For purposes of treatment, payment, and operations, including assessment of eligibility, case management activities, coordination of care, collection of premium, payment of benefits, and other claims administration.
  • With a regulatory, law enforcement, or other government authority as required by law. This may include finding or preventing criminal activity, fraud, material misrepresentation or material nondisclosures in connection with an insurance issue.
  • In response to an administrative or judicial order, including a search warrant or subpoena.
  • With a medical care institution or professional, to verify coverage, conduct an audit of their activities, discuss a medical problem of which the insured may not be aware, discuss drug and disease management approaches, and other purposes permitted or required by law.
  • To conduct actuarial or research studies. In this case, individuals are not identified in the research report. Material identifying an individual is destroyed as soon as it is no longer needed.
  • With our business associates for use in auditing services or operations, auditing marketing services, performing various functions on our behalf, or to provide certain services.
  • With a group policyholder for reporting claims experience, or for conducting an audit of our operations or services.
  • To consult with outside health care providers, consultants and attorneys, and other health related services.
  • As otherwise permitted or required by law.

We require those with whom we share information to implement appropriate safeguards regarding your Personal Information, as they are also governed by the federal privacy and security law. We share only that which is minimally necessary to accomplish a task. Information that we get from a report made by a company that assists us to conduct insurance business may be retained by that company and used for other purposes. We are prohibited from using or disclosing Personal Information that is genetic information of an individual for underwriting purposes.

Your written authorization is required for uses and disclosures of Personal Information for purposes other than those described above. We will not sell your Personal Information without obtaining your written authorization to do so. If you provide us authorization to use or disclose your Personal Information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose information for the specific purpose contained in the authorization. We are required to retain any records we may have containing your Personal Information for the periods specified in document retention laws. If you revoke your authorization for payment or health care operations, you may jeopardize the administration of the benefits under your health plan.

Your Rights
Upon written request, you have the right to:

  • Inspect and copy certain Personal Information. We may charge a reasonable fee for the costs of copying or mailing.
  • Receive confidential communication of Personal Information.
  • Receive an electronic copy of your Personal Information when it is maintained electronically.
  • Request restrictions on certain uses and disclosures of your Personal Information, although we are not required to agree to a requested restriction.
  • Request an amendment to your Personal Information, although we are not required to agree to an amendment.
  • Receive an accounting of impermissible Personal Information disclosures or disclosures made in compliance with federal law (or state regulations, if applicable) for which an accounting is required.
  • Be notified of a breach of unsecured Personal Information.

We will respond to your request in a timely manner. The written request must reasonably describe the information. The information requested must be reasonably locatable and retrievable.

How to File a Complaint Regarding the Use and Disclosure of Personal Information
If you believe your privacy rights have been violated, you may file a complaint with us, your respective state insurance department, or with the Secretary of Health and Human Services. All complaints must be in writing.

You may not be retaliated against for filing a complaint.

How to Contact Us
You may contact our representative at the following address:

Brenda Johnston
Ken Brown

Notification of a revised privacy notice will be provided through one of the following:

  • U.S. Postal Service
  • Revised Plan Document
  • Internet E-mail.
  • Electronic mail service - Doculivery

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