WESLEYAN UNIVERSITY HEALTH PLANS 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.
Summary: The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
requires health plans to notify plan participants and beneficiaries about the policies and
practices the plans have adopted in order to protect the confidentiality of health information.
This notice describes the health information policy for health information created, received,
or maintained by Wesleyan University health plans; including the Wesleyan health, dental,
retiree health and medical expenses reimbursement account (MERA) plans. This notice is
intended to satisfy HIPAA’s notice requirement.
Wesleyan health plans need to create, receive, and maintain records that contain health
information in order to administer the plans and provide health care benefits. This notice
- Ways the plans may use and disclose protected health information.
- Your rights with respect to this information.
- Obligations the plans have regarding the use and disclosure of protected health information.
This notice does not, however, address the health information policies or practices of health
Wesleyan Health Plans Pledge Regarding Health Information Privacy
information that relate to a physical or mental health condition or the payment of health care
expenses; and that identifies you, or could be used to identify you. This information is
known as "protected health information". Your protected health information will not be used
or disclosed without a written authorization from you, except as described in this notice.
Protected health information for HIPAA purposes does not include medical information
Wesleyan maintains in its role as an employer as opposed to its role as a health plan
sponsor. This information includes medical information Wesleyan needs to carry out is
obligations under the Family and Medical Leave Act (FMLA), the American with
Disabilities Act (ADA), and similar laws; as well as medical information related to requests
for worker compensation, disability benefits or sick leave; and medical information related
to fitness-for-duty tests. Wesleyan will, however, maintain the confidentiality of this kind of
information as it has in the past and it will only be used for employment related purposes.
Privacy Obligations of Wesleyan Health Plans
Wesleyan health plans are required by law to:
- Make certain that protected health information is kept private as provided in this
- Give you this notice of the plans’ legal oblations, and their policies and privacy
- practices, concerning protected health information.
- Follow the terms of their current privacy notice.
How Wesleyan Health Plans May Use and Disclose Protected Health Information
The following are the different ways the plans may use and disclose protected health
- A Wesleyan health plan may disclose protected health information to a health care provider who renders treatment on your behalf. For example, if you are unable to provide your medical history as the result of an accident, a plan may advise an emergency room physician about the types of prescription drugs you currently take.
- A Wesleyan health plan may use and disclose protected health information so that claims for health care treatment, services and supplies are paid according to plan terms.
- A Wesleyan health plan may use and disclose protected health information so that the plan to may operate, or operate more efficiently, and to make certain all participants receive their health benefits. For example, a plan may use protected health information for case management or to perform population-based studies designed to reduce health care costs. In addition, a plan may use or disclose protected health information in order to conduct compliance reviews, audits, actuarial studies, and/or for fraud and abuse detection.
- A Wesleyan health plan may also consolidate health information about many plan participants and disclose it to the University in summary fashion so the University can decide what coverages the plan should provide. A plan may remove information that identifies you from health information disclosed to the University so the information may be used without the University knowing the identify of specific participants.
- A Wesleyan health plan may disclose protected health information to designated
members of the Human Resources Department who are involved in plan
administration. Such disclosures will be made to these members of Human Resources
only to the extent needed to enable them to fulfill their plan administration
responsibilities. These individuals will protect the privacy of protected health
information and make certain it is used only as described in this notice and as
permitted by law. Unless authorized by you in writing, your protected health
- May not be disclosed by the plans to any other University employee.
- Will not be used by the University for any employment-related actions and decisions or in connection with any other employee benefit plan sponsored by the University.
To a Business Associate
- Certain services are provided Wesleyan health plans by third party administrators known as "business associates." These include CIGNA and Delta Dental. Wesleyan health plans will require business associates, by contract, to appropriately safeguard your protected health information.
Health Related Benefits and Services and Treatment Alternatives
- A Wesleyan health plan may use and disclose protected health information for the purpose of informing you about possible health related benefits and services, and treatment options or alternatives, that may be of interest to you.
Individual Involved in Your Care or Payment of Your Care
- A Wesleyan health plan may disclose protected health information to a close friend or family member involved in, or who helps pay for, your health care. A plan may also advise a family member or close friend about your condition, your location (for example, that you are in the hospital), or death.
As Required by Law
- A Wesleyan health plan will disclose protected health information when required to do so by federal, state, or local law, including laws that require the reporting of certain types of wounds or physical injuries.
Special Use and Disclosure Situations
Wesleyan health plans may also use or disclose protected health information under the following circumstances:
Lawsuits and Disputes
- If you become involved in a lawsuit or other legal action, a Wesleyan health plan may disclose protected health information in response to a court or administrative order, a subpoena, warrant, discovery request, or other lawful due process.
- A Wesleyan health plan may release protected health information if asked to do so by a law enforcement official; for example, to identify or locate a suspect, material witness, or missing person or to report a crime, the crime's location or victims, or the identity, description, or location of the person who committed the crime.
- A Wesleyan health plan may disclose protected health information to the extent authorized by, and to the extent necessary, to comply with workers' compensation laws or other similar programs.
Military and Veterans
- If you are or become a member of the U.S. armed forces, a Wesleyan health plan may release medical information about you as deemed necessary by military command authorities.
To Avert Serious Threat to Health or Safety
- A Wesleyan health plan may use and disclose protected health information when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person.
Public Health Risks
- A Wesleyan health plan may disclose protected health information for public health activities. These activities include preventing or controlling disease, injury or disability; reporting births and deaths; reporting child abuse or neglect; or reporting reactions to medication or problems with medical products or to notify people of recalls of products they have been using.
Health Oversight Activities
- A Wesleyan health plan may disclose protected health information to a health oversight agency for audits, investigations, inspections, and licensure necessary for the government to monitor the health care system and government programs.
- Under certain circumstances, a Wesleyan health plan may use and disclose protected health information for medical research purposes.
National Security, Intelligence Activities, and Protective Services
- A Wesleyan health plan may release protected health information to authorized federal officials:
- for intelligence, counterintelligence, and other national security activities authorized by law and
- to enable them to provide protection to the members of the U. S. government or foreign heads of state, or to conduct special investigations.
Organ and Tissue Donation
- If you are an organ donor, a Wesleyan health plan may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank to facilitate organ or tissue donation and transplantation.
Coroners, Medical Examiners, and Funerals Directors
- A Wesleyan health plan may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. The plans may also release protected health information to a funeral director, as necessary, to carry out his/her duty.
Your Rights Regarding Your Protected Health Information
Your rights regarding protected health information Wesleyan health plans maintain about
Right to Inspect and Copy
- You have the right to inspect and copy your protected health information. This includes information about your eligibility, claim and appeal records, and billing records, but does not include psychotherapy notes. To inspect and copy protected health information maintained by Wesleyan health plans, submit your request in writing to Wesleyan’s Director of Employee Benefits. In limited circumstances, the plans may deny your request to inspect and copy your protected health information. Generally, if you are denied access to this health information, you may request a review of the denial.
Right to Amend
- If you feel that health information maintained by a Wesleyan health plan about you is incorrect or incomplete, you may ask the plan to amend it. You have the right to request an amendment for as long as the information is kept by or for the plan.
- To request an amendment, send a detailed request in writing to the Director of Employee Benefits. You must provide the reason(s) to support your request. The plan may deny your request if you ask the plan to amend health information that was accurate and complete; not created by the plan; not part of the health information kept by or for the plan; or not information that you would be permitted to inspect and copy.
Right to An Accounting of Disclosures
- You have the right to request an "accounting of disclosures." This is a list of disclosures of your protected health information that a Wesleyan health plan has made to others, except for those necessary to carry out health care treatment, payment, or operations; disclosures made to you; or in certain other situations.
- To request an accounting of disclosures, submit your request in writing to the Director of Employee Benefits. Your request must state a time period, which may not be longer than six years prior to the date the accounting was requested.
Right to Request Restrictions
- You have the right to request a restriction on the health information Wesleyan health plans use or disclosure about you for treatment, payment, or health care operations.
- You also have the right to request a limit on the health information a Wesleyan health plan discloses about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that the plan not use or disclose information about a surgery you had.
- To request restrictions, make your request in writing to the Director of Employee Benefits. Your request should state:
- (1) what information you want to limit;
- (2) whether you want to limit the plan's use, disclosure, or both; and (3) to whom you want the limit(s) to apply.
- Note: The Plan is not required to agree to your request.
Right to Request Confidential Communications
- You have the right to request that a Wesleyan health plan communicate with you about health matters in a certain way or at a certain location. For example, you can ask that the plan send you explanation of benefits (EOB) forms about your benefit claims to a specified address.
- To request confidential communications, make your request in writing to the Director of Employee Benefits. The plans will make every attempt to accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of this Notice
- You have the right to a paper copy of this notice. You may write to the Director of Employee Benefits to request a written copy of this notice at any time.
Changes to this Notice
Wesleyan health plans reserve the right to change this notice at any time and to make the revised or changed notice effective for health information a plan already has about you, as well as any information a plan receives in the future. A copy of the current privacy notice for Wesleyan health plans will be posted in the University's Human Resources Office at all times.
If you believe your privacy rights under this policy have been violated, you may file a written complaint with the Director of Employee Benefits at the address listed below. Alternatively, you may complain to the Secretary of the U.S. Department of Health and Human Services, generally, within 180 days of when the act or omission complained of occurred.
Note: You will not be penalized or retaliated against for filing a complaint.
Other Uses and Disclosures of Health Information
Other uses and disclosures of health information not covered by this notice or by the laws that apply to Wesleyan health plans will be made only with your written authorization. If you authorize a plan to use or disclose your protected health information, you may revoke the authorization, in writing, at any time. If you revoke your authorization, the plan will no longer use or disclosure your protected health information for the reasons covered by your written authorization; however, the plan will not reverse any uses or disclosures already made in reliance on your prior authorization.
If you have any questions about this notice, please contact:
Director of Employee Benefits
212 College Street
Middletown, CT 06459
Telephone Number: 860 685 4889
Notice Effective Date: November 1st , 2006