NOTICE OF PRIVACY PRACTICES
EyeMed Vision Care, LLC (“EyeMed”)
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
OUR LEGAL
DUTY
We are required by applicable federal
and state law to maintain the privacy of your health information.
We are also required to give you this Notice about our privacy practices,
our legal duties, and your rights concerning your health information.
We must follow the privacy practices that are described in this
Notice while it is in effect. This Notice takes effect April
14, 2003, and will remain in effect until we replace it.
We reserve the right to change our
privacy practices and the terms of this Notice at any time, provided
such changes are permitted by applicable law. We reserve the right
to make the changes in our privacy practices and the new terms of
our Notice effective for all health information that we maintain,
including health information we created or received before we made
the changes. In the event we make a material change in our privacy
practices, we will change this Notice and provide it to you or it
can be viewed on our Web site.
You may request a copy of our Notice
at any time. For more information about our privacy practices, or
for additional copies of this Notice, please contact us using the
information listed at the end of this Notice.
______________________________________________________
USES AND DISCLOSURES OF HEALTH
INFORMATION
We use health information about you for treatment, to obtain payment for treatment,
for administrative purposes, and to evaluate the quality of care
and service that you receive. Your health information is contained
in a record that is the physical property of EyeMed.
How We May Use
or Disclose Your Health Information
For Treatment. We may use or disclose your health information to an optometrist, ophthalmologist,
optician or other healthcare providers providing treatment to you
for:
·
the provision, coordination,
or management of health care and related services by health care
providers;
·
consultation between
health care providers relating to a patient/customer;
·
the referral of a
patient for health care from one health care provider to another.
For Payment. We may use and disclose your health information to facilitate payments of benefits
for treatment and services provided to you. This may include:
·
billing and collection
activities and related data processing;
·
actions by a health
plan or insurer to determine or fulfill its responsibilities for
coverage and provision of benefits under its health plan or insurance
agreement, determinations of eligibility or coverage, or subrogation
of health benefit claims;
·
medical necessity
and appropriateness of care reviews, utilization review activities;
and
·
disclosure to consumer
reporting agencies of information relating to collection of payments.
For Health Care Operations. We may use and disclose health information about you
for operational purposes. Health care operations include:
·
rating the insurance
risk related to the benefit and determining premiums for the plan;
·
conducting quality
assessments and improvement activities;
·
conducting or arranging
for medical review, legal services, audit services, fraud and abuse
detection and compliance programs;
·
business planning
and development.
To You, Your Family and Friends. We must disclose your health information to you, as
described in the Your Health Information Rights section of this
Notice. We may disclose your health information to a family member,
friend or other person to the extent necessary to help with your
healthcare or with payment for your healthcare, but only if you
agree that we may do so or, if you are not able to agree, if it
is necessary in our professional judgment.
Persons Involved in Care. We may use or disclose health information to notify,
or assist in the notification of (including identifying or locating)
a family member, your personal representative or another person
responsible for your care, of your location or your general condition.
Prior to use or disclosure of your health information, we will provide
you with an opportunity to object to such uses or disclosures. If
you are not present or in the event of your incapacity or emergency
circumstances, we will disclose health information based on a determination
using our professional judgment disclosing only health information
that is directly relevant to the person’s involvement in your healthcare.
Required by Law. We may use and disclose information about you as required by law. For
example, we may disclose information for the following purposes:
·
for judicial and administrative
proceedings pursuant to legal authority;
·
to report information
related to victims of abuse, neglect or domestic violence;
·
to assist law enforcement
officials in their law enforcement duties; or
·
to assist public health
officials avert a serious threat to the health or safety of you
or any other person.
Decedents. Health Information may be disclosed to funeral directors or coroners to enable
them to carry out their lawful duties.
Organ/Tissue Donation. Your health information may be used or disclosed for
cadaveric organ, eye or tissue donation purposes.
Government Functions. Specialized government functions such as protection
of public officials or reporting to various branches of the armed
services that may require use or disclosure of your health information.
Workers Compensation. Your health information may be used or disclosed in
order to comply with laws and regulations related to Workers Compensation.
Marketing Health Products or Services. We will not use your health information for marketing communications without
your prior written authorization. We may provide you with information
regarding products or services that we offer related to your health
care needs. We will never sell your health information without
your prior authorization.
Your Authorization. In addition to our use of your health information for
treatment, payment or healthcare operations, you may give us written
authorization to use your health information or to disclose it to
anyone for any purpose. If you give us an authorization, you may
revoke it in writing at any time. Your revocation will not affect
any use or disclosures permitted by your authorization while it
was in effect. Unless you give us a written authorization, we cannot
use or disclose your health information for any reason except those
described in this Notice.
Your Employer or Organization Sponsoring Your Health Plan: We may disclose your Protected Health Information and the Protected Health
Information of others enrolled in your group insurance plan to the
employer or other organization that sponsors your group insurance
plan to permit the plan administrator to perform plan administration
functions. We may also disclose summary information about the enrollees
in your group insurance plan to the plan administrator to use to
obtain premium bids for the health insurance coverage offered through
your group insurance plan or to decide whether to modify, amend
or terminate your group insurance plan. The summary information
we may disclose will summarize claims history, claims expenses,
or types of claims experienced by the enrollees in your group insurance
plan. The summary information will be stripped of demographic information
about the enrollees in the group insurance plan, but the plan administrator
may still be able to identify you or other participants in your
group health plan from the summary information.
We may also disclose enrollment and disenrollment information to either the
plan administrator or plan sponsor of your group insurance plan.
Underwriting: We may receive your
Protected Health Information for underwriting, premium rating or
other activities relating to the creation, renewal or replacement
of a contract of health insurance or health benefits. We will not
use of further disclose this Protected Health Information for any
other purpose, except as required by law, unless the contract of
health insurance or health benefits is placed with us, or where
we disclose such information to MIB Group, Inc., a non-profit membership
organization of life and health insurance companies, which operates
an information exchange on behalf of its members. In those cases,
our use and disclosure of your Protected Health Information will
only be as described in this notice.
YOUR HEALTH INFORMATION RIGHTS
Access: You have the right to review or get copies of your
health information, with limited exceptions. You may request that
we provide copies in a format other than photocopies. We will use
the format you request unless we cannot practicably do so. You may
be asked to make a request in writing to obtain access to your health
information. You may obtain a form to request access by using the
contact information listed at the end of this Notice. We will charge
you a reasonable cost‑based fee for expenses such as copies
and staff time. You may also request access by sending us a letter
to the address at the end of this Notice setting forth the specific
information to which you desire access. If you request an alternative
format, provided that it is practicable for us to produce the information
in such format, we will charge a cost-based fee for providing your
health information in that format. If you prefer, we will prepare
a summary or an explanation of your health information for a fee.
Contact us using the information listed at the end of this Notice
for a full explanation of our fee structure.
Disclosure Accounting: You have the right to receive a list of instances in
which we or our business associates disclosed your health information
for purposes other than treatment, payment, healthcare operations,
where you have provided an authorization and certain other activities,
for the last 6 years, but only for disclosures made on or after
April 14, 2003 or the date coverage became effective for you, whichever
is later. If you request this accounting more than once in a 12‑month
period, we may charge you a reasonable, cost‑based fee for
responding to these additional requests.
Restriction: You have the right to request that we place additional
restrictions on our use or disclosure of your health information.
We are not required to agree to these additional restrictions, but
if we do, we will abide by our agreement (except in an emergency).
Alternative Communication: You have the right to request in writing that we communicate
with you about your health information by alternative means or to
alternative locations. Your request must specify the alternative
means or location.
Amendment: You have the right to request that we amend your health information. Your request
must be in writing, and it must explain why the information should
be amended. We may deny your request under certain circumstances.
You may obtain a form to request an amendment to your health information
by using the contact information listed at the end of this Notice.
Electronic Notice: If you receive this Notice on our Web site or by electronic mail (e‑mail),
you are entitled to receive this Notice in written form.
QUESTIONS
AND COMPLAINTS
If you want more information about
our privacy practices or have questions or concerns, please contact
us.
If you are concerned that we may
have violated your privacy rights, or you disagree with a decision
we made about access to your health information or in response to
a request you made to amend or restrict the use or disclosure of
your health information or to have us communicate with you by alternative
means or at alternative locations, you may complain to us using
the contact information listed at the end of this Notice. 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 the privacy
of your 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.
Contact Information
If you have any questions or complaints,
please contact:
Privacy Office
EyeMed Vision Care, LLC
4000 Luxottica Place
Mason, Ohio 45040
Phone: 513-765-4321
Email: privacyoffice@eyemedvisioncare.com
Web site: www.eyemedvisioncare.com
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