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.
Statement of Our Duties
We are required by law to maintain the privacy of your personal health information and to provide you with this notice of our privacy practices and legal duties. We are required to abide by the terms of this notice. We reserve the right to change the terms of this notice and to make any new provisions effective to all of the personal health information that we maintain about you. If we revise this notice, we will provide you with a revised notice by mail, or electronically. If the notice is provided electronically, you have the right to request a paper copy of the revised notice.
Statement of Your Rights
You have a right to know how we may use or disclose your personal health information. This notice informs you of those uses and disclosures. There are certain uses and disclosures of your personal health information that we are permitted or required to make by law without your permission. For all other uses and disclosures, we first must obtain your permission. In addition, you have the following rights:
- The right to request that we place additional restrictions on our uses and disclosures of your personal health information. However, we are not obligated to agree to impose any such additional restrictions.
- The right to access, inspect and copy the protected information pertaining to you that we maintain in our files about you, and the right to have us correct or amend any information that we create in error. Requests to access or amend your health information should be sent to the contact person and address provided in paragraph 6.
- The right to receive an accounting of the disclosures of your personal health information that we make for purposes other than activities related to your treatment, or our payment functions or other health care operations.
- The right to request that you receive communications of personal health information in a confidential manner.
- If you received this notice electronically, you have the right to obtain a paper copy of this notice from us on request.
Information We May Collect About You
We may collect the following categories of information about you from the following sources:
- Information that we obtain directly from you, in conversations or on applications or other forms that you fill out.
- Information that we obtain as a result of our transactions with you.
- Information that we obtain from your medical records or from medical professionals.
- Information that we obtain from other entities, such as health care providers or other insurance companies, in order to service your policy or carry out other insurance-related needs.
Permissible Uses & Disclosures of Protected Information
- To carry out treatment functions. We may use or disclose your health information without your permission to allow healthcare providers to provide you with treatment.
- To carry out payment functions. We may use or disclose your health information without your permission to conduct activities related to reimbursing you for health care services, obtaining premiums, determining coverage, and providing benefits under your insurance policy. These functions may include reviewing healthcare services for medical necessity, policy coverage, appropriateness of care, or justification of charges.
- To carry out certain operations related to your benefit plan. We may use or disclose your protected health information without your permission to conduct limited activities related to your health insurance benefits. These activities may incude reviewing the competence or qualifications of healthcare professionals, conducting quality assessments, modifying benefits through insurance contracts or other means, and securing stop-loss insurance or reinsurance contracts.
- To plan sponsors. We may disclose your protected health information to plan sponsors. in accordance with restrictions imposed by plan documents.
- In situations permitted or required by law. We may use or disclose your protected health information without your written permission for purposes permitted or required by law, including the following:
- As authorized by and to the extent necessary to comply with workers’ compensation or other no-fault laws.
- To a health oversight agency for activities including audits or civil, criminal, or administrative proceedings.
- To a public health authority for purposes of public health activities such as reporting product defects to the Food and Drug Administration.
- To a law enforcement official for law enforcement purposes or in response to a court order or in the course of any judicial or administrative proceeding.
- To organ procurement organizations or other entities for approved research purposes.
- To a government authority, including social services or protective services, authorized to receive reports of abuse, neglect, or domestic violence.
- For any purposes to which you have not objected. In certain limited circumstances, we may use or disclose your protected health information after we have given you an opportunity to object and you have not done so. For example, if you do not object, we may use limited information about you to maintain an office directory, notify family members or others involved in your care or payment for care, or in emergency circumstances.
- For purposes requiring your written permission. All other uses or disclosures of your protected health information will be made only with your written permission. You may revoke this permission at any time.
Complaints About Misuse of Health Information
If you believe your rights regarding the protection of your health information have been violated, you may file a complaint with us or with the Secretary of Health and Human Services. To file a complaint with us, submit a written complaint that includes as many details, such as names and dates. You will not face retaliation for filing a complaint. Following is the address for filing a complaint:
f you believe your rights regarding the protection of your health information have been violated, you may file a complaint with us or with the Secretary of Health and Human Services.
To file a complaint with us, submit a written complaint that includes as many details as possible, such as names and dates. You will not face retaliation for filing a complaint.
The address for filing a complaint is:
John Fleischer
Senior Vice President, Chief Technology Officer
CBIZ, Inc.
5959 Rockside Woods Blvd. N, Suite 600
Cleveland, OH 44131
(216) 525-1947
Our Practices Regarding Confidentiality & Security
We restrict access to nonpublic personal information to employees who need it to provide products or services to you. We maintain physical, electronic, and procedural safeguards in compliance with federal regulations to guard your nonpublic personal information.
Our Policy Regarding Dispute Resolution
Any controversy or claim related to our privacy policy, including alleged breaches, will be settled through arbitration in accordance with the rules of the American Arbitration Association. A court jurisdiction may enter judgment on the arbitrator’s decision.
Contact for Filing Complaints or Obtaining Information
To file a complaint about the misuse of health information or to request more information about this notice, please contact:
John Fleischer
Senior Vice President, Chief Technology Officer
CBIZ, Inc.
5959 Rockside Woods Blvd. N, Suite 600
Cleveland, OH 44131
(216) 525-1947