NOTICE OF PRIVACY PRACTICES OF
FIDELIS CARE NEW YORK
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.
In order to provide you with the benefits to which you are entitled, Fidelis must collect, create and maintain health information about you. Fidelis is required by law to maintain the privacy of this information. This Notice of Privacy Practices describes how Fidelis uses and discloses your health information, and explains certain rights you have regarding this information. Fidelis is required by law to provide you with this Notice and we will comply with its terms during the period when it is effective.
How Fidelis Uses and Discloses Your Health Information
The following is a list of the ways in which Fidelis may use and disclose your health information. We will use and disclose your health information only for one of the purposes on this list. In certain cases we provide examples of the types of uses or disclosures that fall within a particular category. These examples are intended to help you understand what these categories mean; they do not cover every type of use or disclosure within each category. Please note that, as discussed later in this Notice of Privacy Practices, special rules apply to our disclosure of certain alcohol and drug abuse treatment records.
a. Treatment. We may use and disclose health information about you to facilitate treatment by health care providers. For example, if one of our participating health care providers is treating you, we may disclose to this provider health information relating to other health care services you have received that may be relevant to the provider's treatment.
b. Payment. We may use and disclose health information about you for our own payment purposes and to assist in the payment activities of other health plans and health care providers. Our payment activities include collecting premiums, determining your eligibility for benefits, reimbursing health care providers that treat you and obtaining payment from other insurers that may be responsible for providing coverage to you. For example, if a health care provider submits a bill to us for services you received, we may use health information about you to determine whether these services are covered under your benefit plan and the appropriate amount of payment to which the provider may be entitled.
c. Health Care Operations. We may use and disclose health information about you to carry out health care operations, which includes quality improvement activities, evaluating our own performance and resolving any complaints or grievances you may have. For example, we may collect and review records maintained by doctors and hospitals that have treated you to see whether they have provided you with preventive treatment and other important health services that are recommended by medical authorities. We may also use and disclose your health information to assist other health plans and health care providers in performing certain health care operations, such as quality assessment and improvement, reviewing the competence and qualifications of health care providers and conducting fraud detection or compliance.
d. Appointment Reminders. We may use and disclose your health information to remind you about appointments you have made to receive health care services or to encourage you to make such appointments.
e. Treatment Alternatives. We may use and disclose your health information to tell you about treatment alternatives or other health-related benefits and services that may be of interest to you.
a. As required by law. We may use and disclose your health information as required by state, federal or local law.
b. For public health activities. We may disclose your health information to public health authorities or other agencies and organizations conducting public health activities, such as preventing or controlling disease, injury or disability and reporting births, deaths, child abuse or neglect, domestic violence, potential problems with products regulated by the Food and Drug Administration or communicable diseases.
c. About victims of abuse, neglect or domestic violence. We may disclose your health information to an appropriate government agency if we believe you are a victim of abuse, neglect or domestic violence and you agree to the disclosure or the disclosure is required or permitted by law. We will let you know if we disclose your health information for this purpose unless we believe that letting you know would place you at risk of serious harm or we believe that a person who usually receives information from us on your behalf is responsible for the abuse, neglect or domestic violence.
d. For health oversight activities. We may disclose your health information to health oversight agencies for oversight activities authorized by law such as audits, investigations, inspections and licensing surveys.
e. For judicial and administrative proceedings. We may disclose your health information in the course of any judicial or administrative proceeding in response to an appropriate order of a court or administrative body.
f. For law enforcement purposes. We may disclose your health information to a law enforcement official for a legitimate law enforcement purpose such as: identifying or locating a suspect, fugitive or missing person; complying with a court order, subpoena or administrative request; providing information about a victim of a crime or reporting a death that may be the result of a crime.
g. About deceased individuals. We may disclose your health information to a coroner or medical examiner for purposes such as identifying a deceased person or determining a cause of death. We may also disclose your health information to a funeral director as necessary to assist such a person in carrying out his or her duties.
h. For organ, eye or tissue donations. We may disclose your health information to organ procurement organizations and similar entities for the purpose of assisting them in organ, eye or tissue donation or transplantation activities.
i. To avert a serious threat to health or safety. We may use or disclose your health information to prevent or lessen a serious and immediate threat to your health or safety or to the health or safety of another person or the general public. We will disclose your health information for this purpose only to someone who may be able to prevent or lessen this type of threat.
k. For specialized government functions. We may use or disclose your health information to provide assistance for certain types of government activities. If you are a member of the armed forces of the United States or a foreign country, we may disclose your health information to appropriate military authorities, as they deem necessary to carry out military missions. We may also disclose your health information to federal officials for lawful intelligence or national security activities and for the purpose of providing protective services to the President of the United States and other officials. In addition, if you are in the custody of a correctional institution or law enforcement official, we may disclose your health information to that institution or official for certain purposes.
l. For workers' compensation. We may use or disclose your health information as permitted by the laws governing the workers' compensation program or similar programs that provide benefits for work-related injuries or illnesses.
m. To individuals involved in your care. We may disclose your health information to a family member, other relative or close personal friend assisting you in receiving or obtaining payment for health care services. We will disclose your health information to these individuals only if you tell us to do this or if we advise you that we will do so and you do not object. We may also disclose your health information to disaster relief organizations such as the Red Cross to assist your family members or friends in locating you or learning about your general condition in the event of a disaster.
Your Rights Regarding Your Health Information
You have the following rights regarding your health information:
Sites that are not Maintained by Fidelis
You should be aware that when you are on our website, you could be directed to other sites that are beyond our control. There may also be links to other sites from the website that take you outside our service. Since we do not maintain those sites, we take no responsibility and assume no liability for the privacy policies and practices of any sites outside of our control. Please review the privacy policies and practices of those sites to learn how other entities may store and use your information.
If you believe your privacy rights have been violated, you may file a complaint with Fidelis or the Secretary of the U.S. Department of Health and Human Services. You may file a complaint with Fidelis by writing to Robert Fazzolari, Vice President, Government Relations and Compliance, 95-25 Queens Blvd, 8th Floor, Rego Park, NY 11374. You will not be penalized or retaliated against by Fidelis for filing a complaint.
Changes to this Notice
Fidelis may change the terms of this Notice of Privacy Practices at any time. If we change the terms of this Notice, the new terms will apply to all of your health information, whether created or received by Fidelis before or after the date on which the Notice is changed. We will notify you of changes to this Notice by mailing you a copy of the new Notice within 60 days of the date on which it becomes effective.
If you have any questions or would like additional information about this Notice or Fidelis' privacy practices, please contact Robert Fazzolari, Vice President, Government Relations and Compliance, 95-25 Queens Blvd, 8th Floor, Rego Park, NY 11374.
This Notice of Privacy Practices is effective as of April 14, 2003.