- Notice of Privacy Practices
- Company Disclosure Statement
This is your Health Information Privacy Notice for QCA Health Plan, Inc. and QualChoice Life and Health Insurance Company, Inc.
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 are required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information.
- We will follow the privacy practices described in this notice and provide you with a copy of it.
- We will not use or share your information other than as described here without your written authorization. We will honor your written request to revoke an authorization.
- We will let you know promptly if a breach occurs that may compromise the privacy or security of your information.
- We will not use genetic information to decide whether we will give you coverage or the price of that coverage.
We may use and share your health information without your authorization in the ordinary course of business for Treatment, Payment and Healthcare Operations in the following ways:
- Treatment: We do not provide treatment. We may, however, use or share health information to help manage the healthcare you receive. We may share health information with healthcare providers who request it in connection with your treatment, preventive health, early detection and care management programs, in plans that offer these programs.
- Payment: We use and share health information to manage your account or benefits, to pay your healthcare claims, and to coordinate benefits with other insurers. Example: We share information about you with other health benefit plans that you are covered by in order to coordinate payment for your health services under the terms of your health plan.
- Healthcare operations: We may use and share health information for healthcare operations which include risk and quality assessment and improvement activities, wellness initiatives preventative health initiatives, and performance measurement outcomes. Example: We may use health information in order to develop better coverage and service offering for our insured members, or provide you with case management or care coordination services for conditions like asthma, diabetes or traumatic injury.
In certain situations, you have the right to choose whether we disclose your health information, such as to a family member, close friend, or other person you identify who is involved in your care, for payment for your care, or to assist in disaster relief efforts. If you are not able to tell us your preference, such as if you’re not present or if you’re incapacitated, but we believe it is in your best interest, we may go ahead and share your information.
In the following situations we will not share your health information without your authorization:
- We will not share copies of any psychotherapy notes without your authorization.
- We will not share health information for certain marketing activities without your authorization.
- We will not disclose your health information for a sale where we directly or indirectly receive remuneration without your authorization.
You may authorize us to share your health information with someone else for any reason. For example, you may authorize us to discuss your claims with a family member or advocate. If you have provided your written authorization, and you change your mind, you have the right to revoke the authorization.
Other Uses and Disclosures
As allowed or required by law. We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:
Some of the ways that we may share health information as allowed or required by law include:
Administer your plan: If you are enrolled in a group health plan, we may share health information with your group health plan’s Plan Sponsor, for plan administration, but only if the Plan Sponsor promises to protect your PHI and only use it as allowed by law.
Health oversight, public health and safety: We may share health information to health agencies for oversight, public health, audits, inspections, investigations, for licensing actions, government benefits programs, prevent the spread of disease, to report abuse or neglect, to report adverse events or product defects and to prevent or lessen a serious and imminent threat to public or personal health or safety.
Judicial and administrative proceedings and law enforcement. We may share health information in response to a court or administrative order, subpoena, discovery request, to identify a suspect, fugitive, witness, or missing person or other lawful process.
Workers’ compensation. We may share health information for Workers’ Compensation purposes and similar legal programs that provide benefits for work-related injuries or illness without regard to fault, as authorized by, and necessary to comply with the laws.
Comply with the law. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Specialized government functions. For example: We may share information about individuals who are Armed Forces personnel or foreign military personnel under appropriate military command to authorized federal officials for national security or intelligence activities; and we may share health information about inmates with correctional facilities or custodial law enforcement officials.
Research purposes. We may share health information for research purposes, subject to approval by institutional or private privacy review boards, and certain assurances and representations by researchers about the necessity of using your health information and the treatment of the information during a research project.
Request restrictions. You have the right to ask us to restrict the disclosure of your health information for treatment, payment, or health care operations, except for disclosures required by law. Your request must be in writing. We are not required to agree to this request, but if we do agree, we will honor your request.
Receive confidential communications. You may request that we contact you in a specific way, for example through a different phone number or address that you designate that may be different than the contact information we have on file. We will consider all requests, and must abide by any request where you indicate that you may be in danger if we do not. Your request must be in writing and you must include a statement that disclosure of all or part of the information could endanger you.
Get a copy of health and claims information. You can request a copy of the health and claims records we maintain about you. We will provide a summary or copy of your health and claims records, usually within 30 days of you request. We may charge a reasonable cost-based fee.
Request a correction to health claims and records. You can ask us to correct your health and claims records if you think they are inaccurate or incomplete. We may deny your request but if so, we will tell you why in writing within 60 days.
Request a list (accounting) of disclosures of your health information. You may submit a written request for a list of disclosures of your health information for up to six years before the date of your request. Normally we will provide the list of disclosures within 60 days of the request. We will provide one free accounting per year but may charge a fee for subsequent requests within 12 months. The accounting will not include disclosures for Treatment, Payment or Healthcare Operations, or those made to you, or pursuant to your authorization.
Obtain a paper copy of this notice. You can request a paper copy of this privacy notice and it will be provided, even if you agreed to receive this notice electronically.
File a complaint. If you believe your privacy rights have been violated, you may file a complaint by contacting us using the information below. You also may submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. We support your right to protect the privacy of your protected health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Effective Date and Changes
This notice takes effect on January 1, 2016. We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request and on our website, and if the changes are material, we will redistribute the notice.
For more information on our privacy policies, to assert your rights under HIPAA, or file a privacy complaint please contact:
QualChoice values your trust, and we promise to protect your personal information. This notice explains how we use your information and keep it safe.
You do not need to do anything. We are letting you know you have certain rights, and they are described in this notice. Please read it carefully.
Information We Collect
We save information about you for everyday business uses. The types of personal information we save and share depend on the product or service you have with us. This information can include:
- Social Security Number
- Account balances and payment history
- In some cases, income and tax information
When you are no longer our customer, we may continue to share your information as described in this notice.
How We Gather Your Personal Information
Most of the information we save about you comes from you. You give us your information when you apply for our products and services. We also may get information from:
- Your agent or broker
- Government agencies
- Independent reporting agencies
- Healthcare employees and hospitals who care for you
How We Use and Share Your Personal Information
We may use and share your information inside QualChoice so we can:
- Give you better customer service
- Take care of your accounts quickly
- Review appeals and help you with questions
We will only share your information inside QualChoice as permitted by law.
We do not sell or share your information with outside marketers. However, we may share your information outside of QualChoice for these reasons:
- Work Done by Service Providers and Business Associates. We may share your information with our service providers and Business Associates. These are companies who do business for us or with us. They must keep your information safe. They must limit their use and sharing of your information to only the work they are doing as allowed by law. Since sharing with service providers and Business Associates is part of how our business works, you cannot opt out of sharing your information with them.
- Required by Law. Sometimes the law requires us to share customer information. This includes obeying a valid summons, court order, search warrant or subpoena. You cannot opt out of sharing your information when it is required by law.
- Agents and Brokers. We may share your information with your agent or broker so he or she can give you better service. Our agents and brokers know your privacy is important. You cannot opt out of sharing your information with your agent or broker.
You have the right to ask for a copy of this notice by writing, e-mailing or calling the Privacy Office (see the end of this notice). You can also find this notice on our website.
You have the right to see the information we have about you. You must ask in writing and include your full name, address and policy or account number. We may charge you a small fee for the copies you want.
If you believe our records of your information are wrong, you may ask us in writing to correct the information.
Why Can’t I Limit All Sharing of My Information?
Federal law gives you the right to limit only:
- Information about your credit rating being shared with our business partners for their everyday business purposes
- Our business partners using your information to market to you
- Sharing for non-partners to market to you
If state or local law gives you more rights to limit sharing, QualChoice will limit sharing to obey the law.
We Protect Your Personal Information
We keep physical and electronic safety measures for the protection of your personal information. Only our employees and agents who need your information to do their jobs may have it. Our employees and agents know the importance of these safety measures. We have trained them in the safe handling of your personal information.
Former Customers’ Personal Information
The policies and practices we explain in this notice apply to our current and former customers. When you are no longer a customer, we will keep your information as long as required by law.
Our Privacy Policies
For More information
You may contact us at:
QualChoice is committed to maintaining confidentiality of your personal information. All of our business practices are in compliance with the privacy requirements under the Health Insurance Portability and Accountability Act (HIPAA).
QualChoice does not sell your information to any third-party. QualChoice may share your information with contracted external partners in order to respond to your inquiries and provide services to you on our behalf. Each of our external partners has executed proper agreements that include requirements to keep all of our members' information confidential in accordance with HIPAA.
QualChoice may use personal information received from you to distribute newsletters, respond to on-line questions, marketing and promotional purposes of QualChoice and its affiliates only, for product improvement or other analysis.
While QualChoice uses appropriate security measures within our physical facilities to protect against the loss, misuse or alteration of information collected from our site, email transmitted over the internet is not a completely secure or confidential means of communication. Therefore, you must be aware that your email communication may be accessed or viewed by another internet user while being transmitted. Therefore, QualChoice is not responsible for the security of information sent to QualChoice via the internet. To assure strict security and confidentiality, please contact our Customer Service Department at 800.235.7111.
Our site may contain links to websites not hosted by QualChoice. If you choose to access those websites, please be aware that QualChoice does not guarantee the security or confidentiality of those websites.
You also may obtain any new notice by contacting the Privacy Officer at:
QualChoice Holdings, Inc. is the parent company of QualChoice Life and Health Insurance Company, Inc., and QCA Health Plan, Inc. (collectively ‘QualChoice’).
The following plans are underwritten by QCA Health Plan, Inc. —
- Point of Service (POS) Plans
- Health Maintenance Organization (HMO) Plans
- QuicChoice Short-Term Health Plans
The following plans are underwritten by QualChoice Life and Health Insurance Company, Inc. —
- Preferred Provider Organization (PPO) Plans
- MediQ65 Medicare Supplement Plans
- QualChoice Dental Benefit Plans
- Group Term Life and AD&D
The following plan is offered by QualChoice —
- QualChoice Vision Benefit Plans are underwritten by National Guardian Life Insurance Company and administered by Superior Vision Services, Inc.