LAST REVISED: 06/26/23
HIPAA Statement Regarding Notice of Privacy Practices
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.
Envolve Benefit Options, Inc. (“Envolve”) is both a Covered Entity and a Business Associate as defined and regulated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Covered Entities Duties
Envolve is required by law to maintain the privacy of your protected health information (PHI), provide you with this Notice of our legal duties and privacy practices related to your PHI, abide by the terms of the Notice that is currently in affect and notify you in the event of a breach of your unsecured PHI.
This Notice describes how we may use and disclose your PHI. It also describes your rights to access, amend and manage your PHI and how to exercise those rights. All other uses and disclosures of your PHI not described in this Notice will be made only with your written authorization.
Envolve reserves the right to change this Notice. We reserve the right to make the revised or changed Notice effective for your PHI we already have, as well as any of your PHI we receive in the future. Envolve will promptly revise and distribute this Notice whenever there is a material change to the following:
- The Uses and Disclosures
- Your Rights
- Our Legal Duties
- other privacy practices stated in the notice
We will make any revised Notices available on our website. As a Covered Entity, we will also mail you or email you a copy on request.
Uses and Disclosures of Your PHI
The following is a list of how we may use or disclose your PHI without your permission or authorization:
- Treatment. We may use or disclose your PHI to a physician or other healthcare provider providing treatment to you, to coordinate your treatment among providers, or to assist us in making prior authorization decisions related to your benefits.
- Payment. We may use and disclose your PHI to make benefit payments for the healthcare services provided to you. We may disclose your PHI to another plan for payment purposes to another health plan, a healthcare provider, or other entity. This is subject to the federal Privacy Rules. Payment activities may include:
- processing claims
- determining eligibility or coverage for claims
- issuing premium billings
- reviewing services for medical necessity
- performing utilization review of claims
- HealthCare Operations. We may use and disclose your PHI to perform our dental or vision care operations. These activities may include:
- providing customer services
- responding to complaints and appeals
- providing care coordination
- conducting medical review of claims and other quality assessment
- improvement activities
In our dental or vision care operations, we may disclose PHI to business associates. We will have written agreements to protect the privacy of your PHI with these associates. We may disclose your PHI to another entity that is subject to the federal Privacy Rules. The entity must also have a relationship with you for its healthcare operations. This includes the following:
- quality assessment and improvement activities
- reviewing the competence or qualifications of healthcare professionals
- care coordination
- detecting or preventing dental or vision care fraud and abuse
- Group Health Plan/Plan Sponsor Disclosures. We may disclose your protected health information to a sponsor of a group health plan, such as an employer or other entity that is providing a health care program to you, if the sponsor has agreed to certain restrictions on how it will use or disclose the protected health care information (such as agreeing not to use the protected health information for employment-related actions or decisions).
Other Permitted or Required Disclosures of Your PHI
- Fundraising Activities. We may use or disclose your PHI for fundraising activities, such as raising money for a charitable foundation or similar entity to help finance their activities. If we do contact you for fundraising activities, we will give you the opportunity to opt-out, or stop, receiving such communications in the future.
- Underwriting Purposes. We may use or disclose your PHI for underwriting purposes, such as to make a determination about a coverage application or request. If we do not use or disclose your PHI for underwriting purposes, we are prohibited from using or disclosing your PHI that is generic information in the underwriting process.
- Appointment Reminders/Treatment Alternatives. We may use and disclose your PHI to remind you of an appointment for treatment and medical care with us or to provide you with information regarding treatment alternatives or other health-related benefits and services.
- As Required by Law. If federal, state, and/or local law requires a use or disclosure of your PHI; we may use or disclose your PHI information. We do this when the use or disclosure complies with the law. The use or disclosure is limited to the requirements of the law. There could be other laws or regulations that conflict. If this happens, we will comply with the more restrictive laws or regulations.
- Public Health Activities. We may disclose your PHI to a public health authority to prevent or control disease, injury, or disability. We may disclosure your PHI to the Food and Drug Administration (FDA). We can do this to ensure the quality, safety or effectiveness products or services under the control of the FDA.
- Victims of Abuse and Neglect. We may disclose your PHI to a local, state, or federal government authority. This includes social services or a protective services agency authorized by law to have these reports. We will do this if we have a reasonable belief of abuse, neglect or domestic violence.
- Judicial and Administrative Proceedings. We may disclose your PHI in judicial and administrative proceedings. We may also disclose it in response to the following:
- an order of a court
- administrative tribunal
- discovery request
- similar legal request
- Law Enforcement. We may disclose your relevant PHI to law enforcement when required to do so. For example, in response to a:
- court order
- court-ordered warrant
- summons issued by a judicial officer
- grand jury subpoena
We may also disclose your relevant PHI to identify or locate a suspect, fugitive, material witness, or missing person.
- Coroners, Medical Examiners and Funeral Directors. We may disclose your PHI to a coroner or medical examiner. This may be needed, for example, to determine a cause of death. We may also disclose your PHI to funeral directors, as needed, to carry out their duties.
- Organ, Eye and Tissue Donation. We may disclose your PHI to organ procurement organizations. We may also disclose your PHI to those who work in procurement, banking or transplantation of:
- cadaveric organs
- Threats to Health and Safety. We may use or disclose your PHI if we believe, in good faith, that it is needed to prevent or lessen a serious or imminent threat. This includes threats to the health or safety of a person or the public.
- Specialized Government Functions. If you are a member of U.S. Armed Forces, we may disclose your PHI as required by military command authorities. We may also disclose your PHI:
- to authorized federal officials for national security
- to intelligence activities
- the Department of State for medical suitability determinations
- for protective services of the President or other authorized persons
- Workers’ Compensation. We may disclose your PHI to comply with laws relating to workers’ compensation or other similar programs, established by law. These are programs that provide benefits for work-related injuries or illness without regard to fault.
- Emergency Situations. We may disclose your PHI in an emergency situation, or if you are unable to respond or not present. This includes to a family member, close personal friend, authorized disaster relief agency, or any other person you told us about. We will use professional judgment and experience to decide if the disclosure is in your best interests. If it is in your best interest, we will only disclose the PHI that is directly relevant to the person's involvement in your care.
- Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your PHI to the correctional institution or law enforcement official, where such information is necessary for the institution to provide you with health care; to protect your health or safety; or the health or safety of others; or for the safety and security of the correctional institution.
- Research. In some cases, we may disclose your PHI to researchers when their clinical research study has been approved. They must have safeguards in place to ensure the privacy and protection of your PHI.
Verbal Agreement to Uses and Disclosure of Your PHI
We are permitted to take your verbal agreement to use and disclose your PHI to other people. This includes family members, close personal friends or any other person you identify. You can object to the use or disclosure of your PHI at the time of the request. You can give us your verbal agreement or objection in advance. You can also give it to us at the time of the use or disclose. We will limit the use or disclosure of your PHI in these cases. We limit the information to what is directly relevant to that person’s involvement in your healthcare treatment or payment.
We are permitted to accept your verbal agreement or objection to use and disclose your PHI in a disaster situation. We can give it to an authorized disaster relief entity. We will limit the use or disclosure of your PHI in these cases. It will be limited to notifying a family member, personal representative or other person responsible for you care of your location and general condition. You can give us your verbal agreement or objection in advance. You can also give it to us at the time of the use or disclosure of your PHI.
Uses and Disclosures of Your PHI That Require Your Written Authorization
We are required to obtain your written authorization to use or disclose your PHI, with few exceptions, for the following reasons:
- Sale of PHI. We will request your written approval before we make any disclosure that is deemed a sale of your PHI. A sale of your PHI means we are getting paid for disclosing the PHI in this manner.
- Marketing. We will request your written approval to use or disclose your PHI for marketing purposed with limited exceptions. For example, when we have face-to-face marketing communications with you or, when we give promotional gifts of nominal value.
- Psychotherapy Notes. We will request your written approval to use or disclose any of you psychotherapy notes to the extent that we may have this information on file with limited exceptions; for example, for certain treatment, payment or healthcare operation functions.
All other uses and disclosures of your PHI not described in this Notice will be made only with your written approval. You may take back your approval at any time. The request to take back approval must be in writing. Your request to take back approval will go into effect as soon as you request it. There are two cases it won’t take effect as soon as you request it. The first case is when we have already taken actions based on past approval. The second case is before we received your written request to stop.
The following are your rights concerning your PHI. If you would like to use any of the following rights, please contact us. Our contact information is at the end of this Notice.
- Right to Revoke an Authorization. You may revoke your authorization at any time, the revocation of your authorization must be in writing. The revocation will be effective immediately, except to the extent that we have already taken actions in reliance of the authorization and before we received your written revocation.
- Right to Request Restrictions. You have the right to ask for restrictions on the use and disclosure of your PHI for treatment, payment or healthcare operations. You can also ask for disclosures to persons involved in your care or payment of your care. This includes family members or close friends. Your request should state the restrictions you are asking for. It should also say to whom the restriction applies. We are not required to agree to this request. If we agree, we will comply with your restriction request. We will not comply if the information is needed to provide you with emergency treatment. However, we will restrict the use or disclosure of PHI for payment or healthcare operations to a health plan when you have paid for the service or item out of pocket in full.
- Right to Request Confidential Communications. You have the right to ask that we communicate with you about your PHI in other ways or locations. This right only applies if the information could endanger you if it is not communicated in other ways or locations. You do not have to explain the reason for your request. However, you must state that the information could endanger you if the change is not made. We must work with your request if it is reasonable and states the other way or location where you PHI should be delivered.
- Right to Access and Received Copy of your PHI. You have the right, with limited exceptions, to look at or get copies of your PHI contained in a designated record set. You may ask that we give copies in a format other than photocopies. We will use the format you ask for unless we cannot practicably do so. You must ask in writing to get access to your PHI. If we deny your request, we will give you a written explanation. We will tell you if the reasons for the denial can be reviewed. We will also let you know how to ask for a review or if the denial cannot be reviewed.
- Right to Amend your PHI. You have the right to ask that we change your PHI if you believe it has wrong information. You must ask in writing. You must explain why the information should be changed. We may deny your request for certain reasons. For example, if we did not create the information you want changed and the creator of the PHI is able to perform the change. If we deny your request, we will provide you a written explanation. You may respond with a statement that you disagree with our decision. We will attach your statement to the PHI you ask that we change. If we accept your request to change the information, we will make reasonable efforts to inform others of the change. This includes people you name. We will also make the effort to include the changes in any future disclosures of that information.
- Right to Receive an Accounting of Disclosures. You have the right to get a list of times within the last 6 year period in which we or our business associates disclosed your PHI. This does not apply to disclosure for purposes of treatment, payment, healthcare operations, or disclosures you authorized and certain other activities. If you ask for this more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. We will give you more information on our fees at the time of your request.
- Right to File a Complaint. If you feel your privacy rights have been violated or that we have violated our own privacy practices, you can file a complaint with us. You can also do this by phone. Use the contact information at the end of this Notice. You can also submit a written complaint to the U.S. Department of Health and Human Services (HHS). See the contact information on the HHS website at www.hhs.gov/ocr. If you request, we will provide you with the address to file a written complaint with HHS. WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT.
- Right to Receive a Copy of this Notice. You may ask for a copy of our Notice at any time. Use the contact information listed at the end of the Notice. If you get this Notice on our website or by email, you can request a paper copy of the Notice.
Additional Information About Privacy and Security
If you have any questions about this Notice, our privacy practices related to your PHI or how to exercise your rights you can contact us in writing. You can also contact us by phone. Use the contact information listed below.
Envolve Benefit Options, Inc.
Attn: Privacy Officer
1151 Falls Road, Suite 2000
Rocky Mount, NC 27804