State Health Benefit Plan and Privacy

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.

The Plan’s Privacy Commitment to You

The Georgia Department of Community Health (DCH) understands that information about you and your family is personal. DCH is committed to protecting your information. This notice tells you how DCH uses and discloses information about you. It tells you your rights and the Plan’s requirements about your information.

Understanding the Type of Information That the Plan Has

Your employer (state agency, school system, authority, etc.) sent information about you to DCH. This information included your name, address, birth date, phone number, Social Security Number and other health insurance policies that you may have. It may also have included health information. When your health care providers send claims to the Plan’s claim administrator for payment, the claims include your diagnoses and the medical treatments you received. For some medical treatments, your health care providers send additional medical information to the Plan such as doctor’s statements, x-rays or lab test results.

Your Health Information Rights

You have the following rights regarding the health information that DCH has about you.

You have the right to see and obtain a copy of your health information. An exception is psychotherapy notes. Another exception is information that is needed for a legal action relating to DCH
You have the right to ask DCH to change health information that is incorrect or incomplete. DCH may deny your request under certain circumstances
You have the right to request a list of the disclosures that DCH has made of your health information beginning from April 2003 forward
You have the right to request added restriction on certain uses or disclosures of your health information. DCH is not required to agree with your request
You have the right to request that DCH communicates with you about your health in a way or at a location that will help you keep your information confidential
You have the right to receive a paper copy of this notice. You may ask DCH staff or your payroll location to give you another copy of this notice, or you may obtain a copy from DCH’s Web site, www.dch.ga.gov

Privacy Law’s Requirements

DCH is required by law to:

Maintain the privacy and security of your information
Give you this notice of DCH’s legal duties and privacy practices regarding the information that DCH has about you
Follow the terms of this notice
Not use or disclose any information about you without your written authorization, except for the reasons given in this notice. You may take away your authorization at any time, in writing, except for the information that DCH disclosed before you stopped your authorization
If you cannot give your authorization due to an emergency, DCH may release the information if it is in your best interest. DCH must notify you as soon as possible after releasing the information.

In the future, DCH may change its privacy practices. If its privacy practices change significantly, DCH will provide a new notice to you. DCH will post the new notice on its Web site at www.dch.ga.gov. This notice is effective April 14, 2006.

How DCH Uses and Discloses Health Care Information

There are some services the Plan provides through contracts with private companies. For example, United HealthCare pays most medical claims to your health care providers, if your plan option is the Preferred Provider Organization (PPO). When services are contracted with United or other companies, the Plan may disclose some or all of your information to the company so that they can perform the job the Plan has asked them to do. To protect your information, the Plan requires the company to safeguard your information in accordance with the law.

The following categories describe different ways that the Plan uses and discloses your health information. For each category, we will explain what we mean and give an example.

For Payment: The Plan may use and disclose information about you so that it can authorize payment for the health services that you received. For example, when you receive a service covered by the Plan, your health care provider sends a claim for payment to the claims administrator. The claim includes information that identifies you, as well as your diagnoses and treatments.

For Medical Treatment: The Plan may use or disclose information about you to ensure that you receive necessary medical treatment and services. For example, if you participate in a Disease State Management Program, the Plan may send you information about your condition.

To Operate Various Plan Programs: The Plan may use or disclose information about you to run various Plan programs and ensure that you receive quality care. For example, the Plan may contract with a company that reviews Hospital records to check on the quality of care that you received and the outcome of your care.

To Other Government Agencies Providing Benefits or Services: The Plan may give information about you to other government agencies that are giving you benefits or services. The information disclosure must be necessary for you to receive those benefits or services and will be authorized by you or by law.

To Keep You Informed: The Plan may mail you information about your health and well-being. Examples are information about managing a disease that you have, information about your managed care choices, and information about Prescription drugs you are taking.

For Overseeing Health Care Providers: The Plan may disclose information about you to the government agencies that license and inspect medical facilities, such as Hospitals, as required by law.

For Research: The Plan may disclose information about you for a research project that has been approved by a review board. The review board must review the research project and its rules to ensure the privacy of your information. The research must be for the purpose of helping the Plan.

As Required by Law: The Plan will disclose information about you as required by law.

For More Information and To Report a Problem

If you have questions and would like additional information, you may contact the SHBP at 404-656-6322 (Atlanta calling area) or 800-610-1863 (outside of Atlanta calling area).

If you believe your privacy rights have been violated:

You can file a complaint with the Plan by calling the SHBP HIPAA Privacy Unit at 404-656-6322 (Atlanta calling area) or 800-610-1863 (outside of Atlanta calling area), or by writing to: SHBP – HPU, P.O. Box 38342, Atlanta, GA 30334.
You may file a complaint with the Health and Human Services’ Office for Civil Rights by writing to:
U.S. Department of Health & Human Services
Office for Civil Rights, Region IV
Atlanta Federal Center
61 Forsyth Street SW, Suite 3B70
Atlanta, GA 30303-8909

There will be no retaliation for filing a complaint.