This notice tells you how your health information may be used and shared by your health plan. It also describes how you can access your own health information. Please review it carefully.
What Is This Document?
This document, called a Notice of Privacy Practices, tells you how Empower may use and share your health information. We must keep your health information private and secure. We will let you know if a breach occurs that affects the privacy or security of your information. The notice also explains how you can get access to your own health information.
What Is Health Information?
The words “health information” mean any information that identifies you. Examples include your name, date of birth, details about health care you received, or amounts paid for your care.
Why Are You Giving This to Me?
We are required by law to give you this notice. We must follow the practices in this notice. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can share your information, you may change your mind at any time. Let us know in writing if you change your mind.
Who Follows This Notice?
All employees, contractors, consultants, vendors, volunteers, and other health care professionals and organizations who work with Empower follow this notice.
How We Can Use and Share Your Health Information
To Manage Your Health Care Treatment. We will use and share your health information to help with your health care.
For Example: A doctor sends us information about your diagnosis and treatment plan, so we can arrange for additional services.
For Example: We may share your health information with a service agency that arranges health care supportive housing services. For Health Care Operations.
To Help Us Do our Job. We may contact you when necessary. We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage.
For Example: We use your health information to develop better services for you or to make sure you are receiving good services.
For Example: We submit data related to your health information to the state to show we are following our contract.
To Pay for your Health Services. We will use and share your health information as we pay for your health services.
For Example: We share information about you with your prescription plan to coordinate payment for your prescriptions. To Administer Your Plan. We may share your health information with other businesses for plan administration.
For Example: We share your information with a transportation company to make sure you get to your important appointment. With Business Associates. We may share your health information with another company, called a business associate, which we hire to provide a service to us or on our behalf. We will only share your information if the business associate has agreed in writing to keep health information private and secure.
Ways We Can Use or Share Your Health Information with Your Permission
You can choose how we share your information in the situations described below. Tell us what you want us to do and we will follow your instructions. If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest.
Individuals Involved in Payment for Your Care. We may share your health information with your family members, friends or other people who are involved in your health care or who help pay for it. You have the right to ask that we not share your information with certain people, but you must let us know. Information About health-Related Benefits, Services and Treatment Alternatives. We may tell you about health services, products, possible treatments or alternatives available to you.
Sensitive Information. Some types of medical information are very sensitive. The law may require that we obtain your written permission to share this information. Sensitive medical information may include genetic testing, HIV/AIDS testing, diagnosis or treatment, mental health, alcohol and substance abuse, sexual assault or in-vitro fertilization. Your permission is also required for the use and sharing of psychotherapy notes.
Use of Your Information for Our Marketing. We may not use or disclose your health information for marketing purposes unless we have your written permission.
Sale of Your Information. We will not sell your health information unless we have your written permission.
How We Must Share Your Health Information
We also have to share your information in situations that help contribute to the public good or safety. We have to meet many conditions in the law before we can share your information for these purposes.
Research. We can use or share your information for health research.
Public Health and Safety. We may share your health information for public health and safety reasons. For example:
- To prevent or control disease
- To help report information about bad products
- To report adverse reactions to medications
- To let you know that you may have been exposed to a disease or may be at risk for getting or spreading a disease or condition
- To your employer in certain limited instances.
Abuse and Neglect. We may have to share your information to report suspected abuse, neglect or domestic violence to state and federal agencies. You will likely be told that we are sharing this information with these agencies.
For Disaster Relief. We may share your health information in a disaster relief situation.
Prevent a Serious Threat to Safety. We may use and share your medical information to prevent or reduce a serious threat to your health and safety or the health and safety of others.
Comply with the Law. We must share health information about you when we are required to do so by federal or state laws.
As a Part of Legal Proceedings. We can share health information about you in response to a court order or a subpoena. We will only share the information stated in the order. If we receive any other legal requests, we may share your health information if we are told that you know about it and do not object to the release.
With Law Enforcement. We must share health information about you when we are required to do so by law or by the court process, including for the following:
- To identify or locate a suspect, fugitive, material witness or missing person
- To obtain information about an actual or suspected victim of a crime
We may also share information with law enforcement if we believe a death was the result of a crime or to report crimes on our property or in an emergency.
During an Investigation. We will share your information with the Secretary of the Department of Health and Human Services if they ask for it as part of an investigation of a privacy violation.
Special Governmental Functions. We may share your health information with:
- Authorized federal officials
- For intelligence, counter-intelligence and other national security activities
- To protect the president
Coroners, Medical Examiners and Funeral Directors. We may share health information with a coroner or medical examiner to identify a dead person or find the cause of death. We also may share health information with funeral directors if they need it to do their job.
Health Oversight Activities. Certain health agencies are in charge of overseeing health care systems and government programs or to make sure that civil rights laws are being followed. We may share your information with these agencies for these purposes.
Organ and Tissue Donation. If you are an organ donor, we may release health information to the organizations in charge of getting, transporting or transplanting an organ, eye or tissue.
Workers Compensation. We may share your health information with agencies or individuals to follow workers compensation laws or other similar programs.
Your Rights Regarding Your Health Information
You Have a Right to Request Restrictions. You have the right to ask us to limit the ways we use and share your health information for treatment, payment, and health care operations. We do not have to agree if it would affect your care. You must submit your request in writing, and it must be signed and dated. You should describe the
information you want limited and tell us who should not receive this information.
You must submit your written request to firstname.lastname@example.org.
We will tell you if we agree with your request or not. If we do agree, we will follow your request unless the information is needed to treat you in an emergency. If we do not agree we will discuss our concerns with you in order to better understand how we can help you.
You Have a Right to Get a Copy of Health and Claims Records. You have the right to read or get a copy of your health and claims records and other health information we have about you. To see and obtain copies of your information you must complete your request in writing. We will give you a copy or a summary of your health and claims record within 30 days of your request. If you request a copy of your health and claims
record, we may charge a reasonable, cost-based fee for the costs of copying, mailing or other expenses associated with your request.
You Have a Right to Request Changes. You may ask us to change your health information or payment record if you think it is incorrect or incomplete. You must send us a written request and you must provide the reason why you want the change. We are not required to agree to make the change. If we do not agree to the requested
change, we will tell you why in writing within 60 days. You may then send another request disagreeing with us. It will be attached to the information you wanted changed or corrected.
You Have a Right to Request Confidential Communication. You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will consider all reasonable requests. We must agree if you tell us you would be in danger if we do not follow your request.
You have the right to make a written request for a list of the times we have shared your health information in the past six years. The list will have who we shared it with, the date it was shared and why. We will include all the disclosures except for those about treatment, payment, and health care operations and any disclosure you asked us to make. We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. Your written request must designate a time period. You have the right to ask for a paper copy of this notice at any time. We will provide you with a paper copy promptly.
You Have a Right to Choose Someone to Act For You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.
Changes To This Notice We may change our privacy policies, procedures, and this Notice at any time, and the changes will apply to all information we have about you. If we change this Notice, the new Notice will be posted on our web site.