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.
The Screen Actors Guild—Producers Health Plan (the "Plan") is required by law to maintain the privacy of your medical information and to provide you with notice of its legal duties and privacy practices with respect to that information. The Plan understands that your medical information is personal and we are committed to protect it. This Notice of Privacy Practices gives you information on how the Plan protects your medical information, when we may use and disclose it and your rights to access and request restrictions to the information.
In most instances, the Plan requires a court order or your written authorization to disclose your medical information. However, the Plan is permitted by law to disclose your medical information without your authorization or court order, as follows:
The Plan may not use or disclose your medical information for any purposes other than the ones outlined above without your written authorization. You may revoke your authorization at any time.
Right to inspect and copy: You may inspect and request copies of your medical information by writing to the Plan's Privacy Officer. You may also have the right to a copy of your medical information in electronic format, but only if it is contained in an Electronic Health Record ("EHR"). A fee may be charged to cover copying and mailing costs and in the case of a request for a copy of your medical information maintained in an electronic format, we may charge you the amount of our labor costs.
Right to Receive Confidential Communications: The Plan normally provides medical information to participants via U.S. mail. You may request that the Plan communicate your medical information to you in a different way. Your request must be made in writing to the Plan's Privacy Officer and explain the reasons for your request. In certain cases, the Plan may deny your request.
Right to Request Restrictions: You have the right to request additional restrictions on how your medical information is used and disclosed. Your request must be made in writing to the Plan's Privacy Officer and explain the reasons for your request.
Right to Amend: If you believe the medical information the Plan maintains about you is incorrect, you have the right to request an amendment to it. Your request must be made in writing to the Plan's Privacy Officer and explain the reasons for your request. In certain cases, the Plan may deny your request.
Right to Receive an Accounting of Disclosures: You have the right to request a listing of the disclosures we have made of your medical information without your authorization for purposes other than treatment, payment of claims and health care operations (unless such disclosures of your medical information are made through an EHR). Your request must be made in writing to the Plan's Privacy Officer and cannot be for a period longer than six years. In certain cases, the Plan may charge a fee for this request.
Right to Obtain a Paper Copy of the Plan's Privacy Notice: If you received this Notice electronically (via email or the Internet), you have the right to request a paper copy at any time.
If you believe your privacy rights have been violated, you have the right to file a formal complaint with the Plan's Privacy Officer and/or with the Secretary of the U.S. Department of Health and Human Services. You cannot be retaliated against for filing a complaint.
The effective date of this Notice is February 17, 2010. The Plan is required by law to abide by the terms of this Notice until replaced. We reserve the right to make changes to this Notice and to make the new provisions effective for all medical information the Plan maintains. If revised, a new Notice will be provided to all participants eligible for or covered by the Plan at that time.
To request additional copies of this Privacy Notice, obtain further information regarding our privacy practices and your rights, or to file a complaint, please contact the Plan's Privacy Officer. This Notice is also posted on our website: www.sagph.org.
|Name:||Privacy Officer, Screen Actors Guild - Producers Health Plan|
P.O. Box 7830
Burbank, CA 91510-7830
3601 West Olive Avenue
Burbank, CA 91505