Privacy Notice

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.

Purpose
Cook Children's Health Plan (CCHP), its staff and volunteers follow the privacy practices described in this notice. We know that information about you (the member) and your health is personal. We will protect the information we have about you. This notice covers all records we have or create about you. Your personal doctor (PCP) may have different policies or notices that tell you how they will use and release your protected health information (PHI) that was created in the doctor's office or clinic.

This notice will tell you how we can use and release PHI about you. It also tells you about your rights and our obligations.

• make sure that any PHI that can identify you is kept private;
• give you notice of our legal duties and privacy practices with respect to your PHI; and
• follow the terms of the notice that is currently in effect.

HOW WILL CCHP USE MY PHI?
This notice tells you about the different ways that we use and release PHI. This notice will not tell you every way we will use or release your PHI. However, all of the ways we can use and release PHI will fall within one of these groups.

For Treatment - We may use PHI about you to direct medical treatment or services for you. We may give PHI about you to:

• doctors;
• nurses;
• technicians; or
• other people who are involved in taking care of you.

For example, CCHP approves the services you receive from certain health care providers other than your PCP. We may talk to those providers about the care they are giving you. We also coordinate services with our behavioral health providers to make sure any medical needs are also being met.

For Payment - We may use and release PHI about you so that the care you receive may be paid correctly to the provider. We may also share your PHI with other insurance companies you may have. For instance, some special services you receive require the provider to get approval from us first. If they don't, the provider might not get paid for those services. In that case, we may talk with the provider about the claim.

For Health Care Operations (HCO) - We may use and release PHI about you for HCO and to see that all of our members get quality care. For example, we may use PHI about you to see if you have a special health care need. If you do, we will see that you get all the services you need by directing those services. We may also use your PHI to look into and solve any complaints that you may file.

Birch & Davis (TexCare Partnership) - We will give PHI about you to Birch & Davis if you:

• are female and pregnant;
• have a special health care need (SHCN); or
• have End-Stage Renal Disease (ESRD).

SPECIAL SITUATIONS
Taking Part in Your Care- Anyone named below who is involved with your care or payment related to your health care may be given PHI. For example:

• a family member,
• relative,
• a close friend of yours, or
• any other person named by you, your parent or legal guardian.

As Required by Law - We will give out PHI about you when we have to by:

• Federal;
• state; or
• local law.

Public Health Activities - We may disclose PHI to a:

• public health agency (PHA) who by law can collect or get PHI to stop or control:
  • disease,
  • injury, or
  • disability,
  This includes the reporting of:
  • disease,
  • injury,
  • events such as birth or death, and
  • the conduct of public health studies, research and interventions; or
  • at the direction of a PHA, to a foreign government agency that is working with a PHA.
• PHA or other government agency who can receive reports of child abuse or neglect;
• person who is under the control of the Food and Drug Administration to:
  • report adverse events;
  • report defects or problems with a product;
  • track products;
  • allow product recalls; or
  • run post-marketing studies;
• person who may have been exposed to a contagious disease;
• employer about an employee to judge whether the person has a work-related illness or injury.

Victims of Abuse, Neglect or Family Violence - We may give PHI to an agency, including a social or protective services agency, allowed by law to get reports about a person who we think is a victim of:

• abuse,
• neglect, or
• family violence

Health Oversight Activities - We may give medical information to a health oversight agency for activities allowed by law. These activities include, for example:

• Audits;
• Investigations;
• Inspections; and
• licensure or disciplinary actions.

They are needed for the government to monitor:

• CCHP;
• government benefit programs;
• entities subject to government regulatory programs to determine compliance with the program standards; or
• entities subject to civil rights laws to determine compliance.

They do not include:

• any investigation or activity that is not related to the receipt of health care,
• a claim for public benefits related to health; or
• qualification for, or receipt of, public benefits or services.

Judicial and Administrative Proceedings - We may give out PHI in the course of any judicial or administrative proceeding in response to:

• an order of a court or administrative tribunal, as long as we only give out the PHI expressly authorized by such order; or
• a subpoena, discovery request, or other lawful process, that is not accompanied by an order of a court or administrative tribunal.

We must receive satisfactory assurance from the party seeking the information that reasonable efforts have been made to ensure that:

• you have been given notice of the request; or
• reasonable efforts have been made to secure a qualified protective order which prohibits the use and disclosure of the PHI for any other purpose; and
• requires the requesting party to return or destroy the PHI at the end of the litigation.

Law Enforcement - We may give PHI to a law enforcement official:

• If, by law, we have to report certain types of wounds, other physical injuries or in compliance with the requirements of a:
  1. court order;
  2. court-ordered warrant;
  3. grand jury subpoena; or
  4. administrative request.
• If needed for identification and location purposes;
• If you are a victim of a crime;
• To report a death if we believe the death was a result of criminal conduct; or
• To report information that we believe shows evidence of criminal conduct that may occur on our premises.

Coroners, Medical Examiners and Funeral Directors - We may give PHI to a coroner or medical examiner. This may be necessary, for example, to:

• identify a person who has died; or
• find out the cause of death.

We may also release PHI about members of CCHP to funeral directors as needed to carry out their duties.

Organ and Tissue Donation - If you are an organ donor, we may give out PHI, as needed to help with organ or tissue donation and transplantation, to organizations:

• that handle organ procurement; or
• organ, eye or tissue transplantation; or
• to an organ donation bank.

Research - Under certain conditions, we may use and give out PHI about you for research purposes. For example, a research project may compare the health and recovery of members with the same health problem such as asthma.

To Prevent a Serious Threat to Health or Safety - CCHP will release PHI about you if needed to prevent a serious threat to your health and safety. Any release, however, would only be to someone able to help prevent the threat.

Appointment Reminders - If needed, CCHP may give out PHI by calling to remind you that you have an appointment for:

• treatment or
• medical care.

Health-Related Benefits and Services - We may use and give out PHI to let you know about health benefits or services that may be of interest to you.

Treatment Choices - We may use and give out PHI to let you know about or suggest possible treatment options or choices that may be of interest.

Inmates - We may release information about you if you are:

• an inmate of a correctional facility; or
• under the custody of a law enforcement official.

• for the facility to provide you with health care;
• to protect your health and safety needs or the health and safety of others; or
• for the safety and security of the correctional facility.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights about medical information we keep about you:

• treatment;
• payment; or
• health care operations.

You also have the right to ask us to limit the medical information we release about you to someone who:

• takes part in your care; or
• pays for your care, like a family member or friend.

For instance, you could ask that we not use or give out information about a surgery you had.

We do not have to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. We may cancel the restriction if you agree to or you request that we cancel it in writing or orally. The oral agreement will be documented.

To ask for restrictions, you must make your request in writing to the Supervisor of Member Services for CCHP. In your request, you must tell us:

• what information you want to limit;
• whether you want to limit our use, disclosure or both; and
• to whom you want the limits to apply.

Right to Receive Private Communications - You have the right to ask to get communications of PHI in certain ways or at certain places. You must clearly state that the release of all or part of that information could cause you harm.

To ask for private communications, you must make your request in writing to the Supervisor of Member Services. Your request must state that the release of all or a part of the information described in the request could cause you harm. If you are asking for a different address or way to get in touch with you, you must give us the:

• other address; or
• the way you want us to contact you.

Right to Inspect and Copy PHI - You have the right to see and ask for copies of medical information we have about you. We may not let you see or get copies of PHI if:

• we obtained it from someone other than a provider and if we promised to keep it confidential; and
• the access requested may tell you the source of the information.

We may also deny a request for access to information. We must give you the right to have the denial reviewed. The review will be done by the Supervisor of Member Services or a designated representative who is:

• named by CCHP to act as a reviewing official; and
• who was not a part of the first decision to deny.

Your request can be turned down if a licensed health care professional feels that the access requested may cause:

• harm to the life or physical safety of that person or another person;
• substantial harm to another person if the PHI makes reference to that other person; or
• substantial harm to you if the request for access is made by the person who represents you and they feel that access to this person could cause you harm.

In order to see or to get copies of PHI, you must send your request in writing to the Supervisor of Member Services. We will send you a response no later than 30 days after receipt of the request.

Right to Change PHI - If you feel that the PHI we have about you is wrong or not complete, you may ask us to make changes to the PHI. You have a right to ask us to make changes for as long as the PHI is kept by or for CCHP.

We may deny a request for changes if:

• the requested PHI was not created by CCHP;
• was not a part of the record; and
• is not available for your inspection under your Right to Inspect and Copy explained above.

To ask for changes to be made, you must send your request in writing. Send it to the Supervisor of Member Services at:

Your request must include a reason to back up your request. We will respond to your request within 60 days of your request. If we deny the requested changes, we will tell you and give you the reasons for the denial.

Right to Receive an Accounting of Disclosures of PHI - You have the right to ask for a record of all the times CCHP has given out your PHI in the 6 years prior to the date of your request. This record does not include disclosures:

• relating to payment, treatment or health care operations;
• made to you;
• to correctional institutions; and
• made prior to April 14, 2003.

We will give you a written record that includes:

• the date the PHI was given out;
• the name of the person who received the information and the address if we have it;
• a brief description of the information that was given out; and
• the purpose of the disclosure.

We will respond to your request within 60 days of your request. You can get one free record within a 12-month period. We may charge you for the cost of giving you the record if you ask for more than one record in that 12-month period. We will tell you how much it costs and give you a chance to cancel or change your request before you have to pay.

Right to Get a Paper Copy of the Notice - You have the right to a paper copy of this notice. You may ask us for a copy of this notice at any time. Even if you want to get this notice through the internet, you can still get a paper copy of this notice. You can get a copy of this notice at our website: www.cookchp.com

You can get a paper copy by calling 1-800-964-2247 or writing to:

CHANGES TO THIS NOTICE

We have the right to change this notice. We have the right to make the revised notice effective for PHI we already have about you as well as PHI we receive in the future. We will give this notice:

• To all covered members of CCHP as of April 14, 2003;
• To all new enrollees at the time they enroll; and
• Within 60 days of a material change to this notice to all covered members of CCHP

Every three years, we will tell you:

• we have this notice; and
• how you can get a copy.

COMPLAINTS

If you think your privacy rights have been broken, you may file a complaint with:

• CCHP; or
• the Secretary of the Department of Health and Human Services.

To file a complaint with CCHP, call Doris Hunt, Vice President of Finance at (817) 334-2247 or (800) 964-2247. All complaints have to be in writing. You will not be penalized for filing a complaint.

OTHER USES OF PHI

CCHP will not use or give anyone any PHI about you that we have not told you about in this notice unless you say we can. If you no longer want us to use or give out any PHI, you must tell us in writing to stop. If you tell us to stop, we will no longer use or give out this other PHI about you. We can not take back any PHI we have already given out. CCHP has to keep records of the services given to you.