NOTICE OF PRIVACY PRACTICES

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1 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. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT: THE DIRECTOR OF HUMAN RESOURCES THE PROVISIONS OF THIS NOTICE ARE EFFECTIVE AS OF December 14, PURPOSE This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information or PHI to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. PHI is information about you that may identify you and that relates to your past, present or future physical or mental health or conditions and related health care services. This Notice also describes your rights in regard to your PHI, including your rights to access and control such information. This Notice describes the medical information practices of Saginaw Valley State University s Flexible Spending Account Plan (the Plan ) and that of any third party that assists in the administration of Plan claims. WE ARE REQUIRED BY LAW TO: Make sure that your PHI is protected; Give you this Notice describing our legal duties and privacy practices with respect to PHI about you; and Follow the terms of the Notice that is currently in effect. USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION Following is a description of potential uses and disclosures of your PHI. Not every possible use or disclosure will be listed. Treatment. We may use and disclose your PHI to facilitate medical treatment or services. For example, we may disclose your PHI to providers to provide information about alternative treatments or to resolve claims issues. Page 1 of 8

2 Payment. We may use and disclose your PHI to determine eligibility for Plan benefits, to facilitate payment for treatment or services you receive from healthcare providers, to determine benefit responsibility under the Plan, to coordinate Plan coverage, or for other payment purposes. We may also share PHI with a utilization review or pre-certification service provider. It is also possible that we may share your PHI with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments. Health Care Operations. We may use and disclose your PHI for Plan operations. Such uses and disclosures of PHI are necessary to administer the Plan. For example, we may use your PHI in connection with conducting quality assessment and improvement activities, underwriting, premium rating, and other activities related to Plan coverage. We may also use your PHI in submitting claims for obtaining legal services, auditing, or business planning and development. Further, your PHI may be used in association with activities related to cost management, business management, or other plan administrative activities. Other Uses and Disclosures. As part of treatment, payment and healthcare operations, we may use and disclose your health information for the following purposes: To inform you of possible treatment options or alternatives. To inform you about health-related benefits or services that may be of interest to you. SPECIAL SITUATIONS Required By Law. We will disclose your health information when required to do so by federal, state or local law. Public Health Activities. Health information may be used or disclosed to a public health authority that is authorized by law to collect or receive such information to prevent or control disease, injury or disability; or to report births and deaths. Health information may be used or disclosed to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition when required or authorized by law. Abuse, Neglect and Domestic Violence. We may disclose your health information to a public health or other appropriate government authority authorized by law to receive reports of child abuse or neglect. Further, we may Page 2 of 8

3 disclose health information about an individual whom we believe to be a victim of abuse, neglect or domestic violence when required or authorized by law. Food and Drug Administration. We may disclose your health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, or biologic product deviations. Additionally, your health information may be used to track products, enable product recalls, make repairs or replacements, or to conduct post marketing surveillance. Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law and as necessary for the government to monitor the health care system, government programs and compliance with civil rights laws. These oversight activities may include audits, investigations, inspections and licensure evaluation. Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your health information in response to a court or administrative order. We may also disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in a lawsuit or dispute. Law Enforcement. We may release your health information if asked to do so by a law enforcement official in situations including, but not limited to the following: As required by law for reporting of certain types of wounds or other physical injuries; In response to a court order, subpoena, warrant, summons or similar process; To identify or locate a suspect, fugitive, material witness, or missing person; To provide information about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement; To provide information about a death we believe may be the result of criminal conduct; To provide information about criminal conduct at our facility; and Under emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime. Coroners, Medical Examiners and Funeral Directors. We may release health information to a coroner or medical examiner for the purpose of identification, determination of a cause of death, or for other legal duties. We may also release your health information to funeral directors as necessary to carry out their duties. Page 3 of 8

4 Organ and Tissue Donation. If you are an organ donor, we may release your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organ, eye or tissue for the purpose of facilitating organ, eye or tissue donation and transplantation. To Avert a Serious Threat to Health or Safety. We may use and disclose your health information when necessary to prevent or lessen a serious threat to the health and safety of a person or the public. Any disclosure would only be to someone able to prevent or lessen the threat. Specialized Government Functions. We may disclose the health information of Armed Forces personnel, veterans and foreign military personnel for authorized activities under the appropriate circumstances. Further, your health information may be disclosed to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities and special investigations, including the provision of protective services to the President, other authorized persons or foreign heads of state, as authorized by law. Workers' Compensation. We may release health information about you in connection with workers' compensation proceedings as required by law. Inmates. We may release your health information to a correctional institution or law enforcement official if you are an inmate of a correctional institution or under the custody of alaw enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. Research. We may disclose your health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION Right to Inspect and Copy. Page 4 of 8

5 With certain limited exceptions, you have the right to inspect and copy designated record sets containing your health information for as long as we maintain the record. A designated record set includes medical, billing, and other records, with the exception of psychotherapy notes, used for making decisions about individuals. A designated record set does not, however, include: (a) duplicate information maintained in other systems; (b) data collected and maintained for research; (c) data collected and maintained for peer review purposes; (d) psychotherapy notes; (e) information compiled in reasonable anticipation of litigation or administrative action; (f) employment records; (g) student records; and (h) source data interpreted or summarized in the individual s medical record (example: pathology slide and diagnostic film). Should your request fall under an exception, you will receive a response explaining the reason for our inability to allow you to inspect and copy the information you requested. In order to inspect or copy a designated record set, you must submit a written request to the Director of Human Resources. We may charge a fee to copy any information. We may also charge a fee to recoup any fees assessed to the Plan by an outside entity, such as a third-party administrator, related to your request for access. The fee for providing an electronic copy may not be greater than our labor costs in responding to the request for such copy. If we use or maintain an electronic health record, or EHR, we will provide a copy of the PHI requested in an electronic format if you request an electronic copy in writing. In addition, if you direct us to, we will transmit the copy directly to an entity or person designated by you, provided that your written directions are clear, conspicuous and specific. Your request to inspect and copy your health information may be denied. If your request is denied, you may request that the denial be reviewed. As used in this Notice, an electronic health record or EHR is an electronic record of healthrelated information pertaining to an individual that is created, gathered, managed, and consulted by authorized healthcare personnel. Right to Amend. You may ask us to amend your health information in a designated record set if you feel that the information is incomplete or inaccurate. You have the right to request an amendment for as long as the information is kept by or for our facility. To request an amendment, you must submit a written request to the Director of Human Resources. You must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. If you are denied the ability to amend your health information, you may request a review of the denial. Possible reasons for denying your request to amend include, but are not limited to: The information was not created by us, unless you provide a reasonable basis to believe that the person or entity that created the information is no longer available to make the amendment; The information is not part of the designated record set maintained by our facility; The information is not part of the designated record set which you would be permitted to inspect; or The request pertains to information that is accurate and complete. Page 5 of 8

6 Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures listing the disclosures we made of your health information. To request an accounting of disclosures, you must submit a written request to the Director of Human Resources. Your request must state a time period that may not be longer than six (6) years for paper records or three (3) years for disclosures to carry out treatment, payment and healthcare operations documented in an EHR. The first accounting will be provided without charge. We may charge you for the costs of providing subsequent accountings within a twelve (12) month period. We will notify you of the costs involved and you may choose to withdraw or modify your request before action is taken. Right to Request Restrictions. You have the right to request a restriction or limitation on certain parts of the health information we use or disclose about you for treatment, payment or health care operations. If you paid outof-pocket for a specific item or service, you have the right to request that medical information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we are required to honor that request. You also have the right to request a limit on the health information we disclose about you for notification purposes or to individuals involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not disclose information about a condition you have to your spouse or children. Except as otherwise noted above, we are not required to agree to your request. Under certain circumstances, we may terminate our agreement to a restriction. You may also terminate a restriction at a later date. Make your written request for restrictions to the Director of Human Resources. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply. You may contact the Director of Human Resources to terminate a restriction. Right to Receive Notice of a Breach of Unsecured Protected Health Information. We are required to notify you by first class mail or by (if you have indicated a preference to receive information by ), of any breaches of Unsecured Protected Health information as soon as possible, but in any event, no later than 60 days following the discovery of the breach. Unsecured Protected Health Information is information that is not secured through the use of a technology or methodology identified by the Secretary of the U.S. Department of Health and Human Services to render the Protected Health Information unusable, unreadable, and undecipherable to unauthorized users. The notice is required to include the following information: a. a brief description of the breach, including the date of the breach and the date of its discovery, if known; b. a description of the type of Unsecured Protected Health Information involved in the breach; Page 6 of 8

7 c. steps you should take to protect yourself from potential harm resulting from the breach; d. a brief description of actions we are taking to investigate the breach, mitigate losses, and protect against further breaches; and e. contact information, including a toll-free telephone number, address, Web site or postal address to permit you to ask questions or obtain additional information. In the event the breach involves 10 or more individuals whose contact information is out of date, we will post a notice of the breach on the home page of our Web site or in a major print or broadcast media. If the breach involves more than 500 individuals in the state or jurisdiction, we will send notices to prominent media outlets. If the breach involves more than 500 individuals, we are required to immediately notify the Secretary. We also are required to submit an annual report to the Secretary of a breach that involved less than 500 individuals during the year and will maintain a written log of breaches involving less than 500 individuals. Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain manner or location. We will accommodate all reasonable requests. For example, you can ask that we only contact you at home or not to send certain items in the mail. To request confidential communications, you must make your request in writing to the Director of Human Resources. You do not need to include a reason for your request; however, your request must be specific as to your requested accommodations. Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. To obtain a paper copy of this Notice, contact the Director of Human Resources. OTHER USES OF PROTECTED HEALTH INFORMATION Other uses and disclosures of your health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us with permission to use or disclose your health information, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. Please understand that we are unable to take back any disclosures we have already made with your permission. SALE OF PHI We will not directly or indirectly receive remuneration or payment in exchange for any PHI unless we obtain a valid authorization that includes a specification of whether the PHI can be Page 7 of 8

8 further exchanged for remuneration by the entity receiving the PHI. The prohibition against selling PHI will not apply if the purpose of the exchange is for: a. public health activities. (The Secretary may issue regulations limiting the price charged for PHI under this exception for public health activities.) b. research, but only if the price charged reflects the costs of preparation and transmittal of the data for such purpose. c. treatment of the individual, subject to any regulation that the Secretary may promulgate to prevent PHI from inappropriate access, use, or disclosure. d. health care operations associated with the sale, transfer, merger or consolidation of all or part of the Company, e. remuneration provided by the Company to a Business Associate pursuant to a legitimate Business Associate services contract or arrangement. f. providing an individual with a copy of his/her medical record; and g. any other purpose approved by the Secretary. THIS NOTICE MAY BE AMENDED AT ANY TIME We may change the terms of this Notice at any time. Any revised Notice will be effective for all health information that we maintain at the time the new version is adopted. The effective date of a revised Notice will be noted on its first page. A copy of the current Notice in effect will be posted. Each time you receive treatment or health care services you may request a copy of the current Notice. In addition, you may always request a copy of the current Notice. COMPLAINTS If you believe your privacy rights have been violated or that our facility has otherwise not complied with the terms of this Notice, you may file a complaint by contacting the Director of Human Resources for further information. All complaints must be submitted in writing. You will not be penalized for filing a complaint. If you feel uncomfortable filing a complaint with us, you may contact the Secretary of the United States Department of Health and Human Services. Page 8 of 8

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