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
This Notice of Privacy Practices
(Notice) applies to Protected Health Information
(defined below) associated with Group Health Plans
(defined below) provided by the Employer sponsoring the
plan. This Notice is provided to you by the plan
sponsor. PayPro Administrators may be a service provider
for claims, reimbursements, and other necessary
operations as required by the plan on behalf of the
employees, the employees dependents and, as applicable,
retired employees. PayPro Administrators may be a
Business Associate of the Covered Entity, and as such,
is required to follow the privacy practices described
herein. This Notice describes how the Group Health Plan
may use and disclose Protected Health Information to
carry out payment and health care operations, and for
other purposes that are permitted or required by law.
The Group Health Plan(s) that this
notice covers, is/are required by the privacy
regulations issued under the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) to
maintain the privacy of Protected Health Information and
to provide individuals covered under the group health
plan with notice of our legal duties and privacy
practices concerning Protected Health Information. We
are required to abide by the terms of this Notice so
long as it remains in effect. We reserve the right to
change the terms of this Notice of Privacy Practices as
necessary and to make the new Notice effective for all
Protected Health Information maintained by us. If we
make material changes to our privacy practices, copies
of revised notices will be provided to all plan
participants covered by the Group Health Plan you may be
a participant of. Copies of your current Notice may be
obtained by contacting the Group Health Plan/Employer
sponsoring the plan(s).
Group Health Plan means, for
purposes of this Notice, the following
employer-sponsored benefits that may be provided to
employees, employee dependents and, as applicable,
retired employees: Flex Spending Accounts, Health
Reimbursement Arrangements, COBRA, and/or other
coverage(s) that meet the definition of a health plan
that PayPro Administrators acts as a service provider
for on behalf of the plan sponsor.
Protected Health Information
(PHI) means individually identifiable health
information, as defined by HIPAA, that is created or
received by us and that relates to the past, present, or
future physical or mental health or condition of an
individual; the provision of health care to an
individual; or the past, present, or future payment for
the provision of health care to an individual; and that
identifies the individual or for which there is a
reasonable basis to believe the information can be used
to identify the individual. PHI includes information of
persons living or deceased.
USES AND DISCLOSURES OF YOUR
PROTECTED HEALTH INFORMATION
The following categories describe
different ways that we use and disclose PHI. For each
category of uses and disclosures we will explain what we
mean and, where appropriate, provide examples for
illustrative purposes. Not every use or disclosure in a
category will be listed. However, all of the ways we are
permitted or required to use and disclose PHI will fall
within one of the categories.
Your Authorization Except as
outlined below, we will not use or disclose your PHI
unless you have signed a form authorizing the use or
disclosure. You have the right to revoke that
authorization in writing except to the extent that we
have taken action in reliance upon the authorization or
that the authorization was obtained as a condition of
obtaining coverage under the group health plan, and we
have the right, under other law, to contest a claim
under the coverage or the coverage itself.
Uses and Disclosures for Payment
We may make requests, uses, and disclosures of your
PHI as necessary for payment purposes. For example, we
may use information regarding your medical procedures
and treatment to process and pay claims. We may also
disclose your PHI for the payment purposes of a health
care provider or a health plan.
Uses and Disclosures for Health Care
Operations We may use and disclose your PHI as
necessary for our health care operations. Examples of
health care operations include activities relating to
the creation, renewal, or replacement of your Group
Health Plan coverage, reinsurance, compliance, auditing,
rating, business management, quality improvement and
assurance, and other functions related to your Group
Family and Friends Involved in Your
Care If you are available and do not object, we
may disclose your PHI to your family, friends, and
others who are involved in your care or payment of a
claim. If you are unavailable or incapacitated and we
determine that a limited disclosure is in your best
interest, we may share limited PHI with such
individuals. For example, we may use our professional
judgment to disclose PHI to your spouse concerning the
processing of a claim.
Business Associates At times we
use outside persons or organizations to help us provide
you with the benefits of your Group Health Plan.
Examples of these outside persons and organizations
might include vendors that help us process your claims.
At times it may be necessary for us to provide certain
of your PHI to one or more of these outside persons or
Other Products and Services We
may contact you to provide information about other
health-related products and services that may be of
interest to you. For example, we may use and disclose
your PHI for the purpose of communicating to you about
our health insurance products that could enhance or
substitute for existing Group Health Plan coverage, and
about health-related products and services that may add
value to your Group Health Plan.
Other Uses and Disclosures We
may make certain other uses and disclosures of your PHI
without your authorization.
We may use or disclose your PHI for
any purpose required by law. For example, we may be
required by law to use or disclose your PHI to
respond to a court order.
We may disclose your PHI for public
health activities, such as reporting of disease,
injury, birth and death, and for public health
We may disclose your PHI to the
proper authorities if we suspect child abuse or
neglect; we may also disclose your PHI if we believe
you to be a victim of abuse, neglect, or domestic
We may disclose your PHI if
authorized by law to a government oversight agency
(e.g., a state insurance department) conducting
audits, investigations, or civil or criminal
We may disclose your PHI in the
course of a judicial or administrative proceeding
(e.g., to respond to a subpoena or discovery
We may disclose your PHI to the
proper authorities for law enforcement purposes.
We may disclose your PHI to
coroners, medical examiners, and/or funeral
directors consistent with law.
We may use or disclose your PHI for
cadaveric organ, eye or tissue donation.
We may use or disclose your PHI for
research purposes, but only as permitted by law.
We may use or disclose PHI to avert
a serious threat to health or safety.
We may use or disclose your PHI if
you are a member of the military as required by
armed forces services, and we may also disclose your
PHI for other specialized government functions such
as national security or intelligence activities.
We may disclose your PHI to workers'
compensation agencies for your workers' compensation
We will, if required by law, release
your PHI to the Secretary of the Department of
Health and Human Services for enforcement of HIPAA.
In the event applicable law, other than
HIPAA, prohibits or materially limits our uses and
disclosures of Protected Health Information, as
described above, we will restrict our uses or disclosure
of your Protected Health Information in accordance with
the more stringent standard.
RIGHTS THAT YOU HAVE
Access to Your PHI You have the
right of access to copy and/or inspect your PHI that we
maintain in designated record sets. Certain requests for
access to your PHI must be in writing, must state that
you want access to your PHI and must be signed by you or
your representative (e.g., requests for medical records
provided to us directly from your health care provider).
Access request forms are available from the us, the
Group Health Plan. Or you may contact PayPro
www.pagroup.us or by calling 951-656-9273. There may
be a fee for copying and postage.
Amendments to Your PHI You have
the right to request that PHI that we maintain about you
be amended or corrected. We are not obligated to make
all requested amendments but will give each request
careful consideration. To be considered, your amendment
request must be in writing, must be signed by you or
your representative, and must state the reasons for the
amendment/correction request. Amendment request forms
are available from us or PayPro Administrators.
Accounting for Disclosures of Your
PHI You have the right to receive an accounting of
certain disclosures made by us of your PHI. Examples of
disclosures that we are required to account for include
those to state insurance departments, pursuant to valid
legal process, or for law enforcement purposes. To be
considered, your accounting requests must be in writing
and signed by you or your representative. Accounting
request forms are available from us at the address
below. The first accounting in any 12-month period is
free; however, we may charge you a fee for each
subsequent accounting you request within the same
Restrictions on Use and Disclosure of
Your PHI You have the right to request
restrictions on certain of our uses and disclosures of
your PHI for insurance payment or health care
operations, disclosures made to persons involved in your
care, and disclosures for disaster relief purposes. For
example, you may request that we not disclose your PHI
to your spouse. Your request must describe in detail the
restriction you are requesting. We are not required to
agree to your request but will attempt to accommodate
reasonable requests when appropriate. We retain the
right to terminate an agreed-to restriction if we
believe such termination is appropriate. In the event of
a termination by us, we will notify you of such
termination. You also have the right to terminate, in
writing or orally, any agreed-to restriction. You may
make a request for a restriction (or termination of an
existing restriction) by contacting us or PayPro
Administrators at the telephone number or address below.
Request for Confidential
Communications You have the right to request that
communications regarding your PHI be made by alternative
means or at alternative locations. For example, you may
request that messages not be left on voice mail or sent
to a particular address. We are required to accommodate
reasonable requests if you inform us that disclosure of
all or part of your information could place you in
danger. Requests for confidential communications must be
in writing, signed by you or your representative, and
sent to us at the address below.
Right to a Copy of the Notice
You have the right to a paper copy of this Notice upon
request by contacting us directly or through the
Business Associate at the telephone number or address
Complaints If you believe your
privacy rights have been violated, you can file a
complaint with us in writing at the address below. You
may also file a complaint in writing with the Secretary
of the U.S. Department of Health and Human Services in
Washington, D.C., within 180 days of a violation of your
rights. There will be no retaliation for filing a
FOR FURTHER INFORMATION
If you have questions or need further assistance
regarding this Notice, you may contact us, the Plan
Sponsor (most likely the employer) directly. Or you may
also contact PayPro Administrators, Privacy Office by
writing to:6180 Quail Valley Court, Riverside, CA 92507
or by calling 951-656-9273.
This Notice is effective April 14, 2003.
This Notice is effective March 2007.
This Notice is effective April 2009.
This Notice is effective August 2010.