El Paso First Health Plans, Inc.

El Paso First Health Plans, Inc.
El Paso First Health Network
1145 Westmoreland Drive
El Paso, Texas 79925
Notice of Privacy Practices

If you would like this Notice in Spanish, please contact El Paso First at 915-532-3778.
Si quiere recibir este aviso en español, favor de comunicarse con El Paso First at 915-532-3778.

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

El Paso First Health Plans, Inc. has implemented a Fraud, Waste & Abuse program as required by law. If you suspect that a person or entity has acted in a possible fraudulent, wasteful, or abusive manner please report such actions to our Fraud Hotline (toll free) at 1 866-356-8395.

In this Notice of Privacy Practices ("Notice"), the El Paso First Health Plan and El Paso First Health Network are collectively referred to as "El Paso First."

El Paso First may use your health information, that is, health information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), for purposes of making or obtaining payment for your care and conducting health care operations. El Paso First has established a policy to guard against unnecessary disclosure of your health information.

In this Notice "medical information" means the same as "health information."

When you receive health care as a member of El Paso First, El Paso First may get health information about you. Health information includes any information that relates to (1) your past, present, or future physical or mental health or condition; (2) providing health care to you; or (3) the past, present, or future payment for your health care.

This Notice tells you about your privacy rights, El Paso First's duty to protect your health information, and how El Paso First may use or disclose your health information without your written permission.

This Notice also tells you what you can do if you feel that your rights have been violated.

YOUR PRIVACY RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION

The law gives you the following rights regarding the health information that El Paso First maintains:

Right to Inspect and Copy Your Health Information.
In most situations, you have the right to look at or get a copy of the health information El Paso First has about you. If you request a copy of your health information, El Paso First may charge a reasonable fee for copying, assembling costs and postage, if applicable, with your request.

Right to Amend Your Health Information.
You may ask El Paso First to correct certain information, including certain health information about you, if you believe the information is wrong or incomplete. El Paso First requires that this request be made in writing. Most of the time, El Paso First cannot change or delete information, even if it is incorrect. However, if El Paso First decides it should make a change, it will add the correct information to the record and note that the new information takes the place of the old information. The old information will remain in the record. If El Paso First denies your request to change the information, you can have your written disagreement placed in your record.

Right to an Accounting of Disclosure.
You may ask for a list of the times El Paso First has disclosed health information about you for any reason other than for treatment, payment or health operations and for those disclosures for which you have provided an authorization. You do not have a right to an accounting of disclosures that were made to correctional institutions or law enforcement officials consistent with the regulations. The request must be made in writing and should specify the time period for which you are requesting the information, but may not start earlier than April 14, 2003. Account requests may not be made for periods of time going back more than six (6) years. El Paso First will provide the first accounting you request during any 12-month period without charge. Subsequent account requests may be subject to a reasonable cost-based fee. El Paso First shall inform you in advance of the fee, if applicable.

Right to Request Restrictions.
You may ask El Paso First to put more limitations on the use or disclosure of your health information than the law requires. You have the right to request a limit on El Paso First's disclosure of your health information to someone involved in the payment of your care. El Paso First requires that any request for a restriction be made in writing. Please note that El Paso First is not required to change the limitations.

Right to Receive Confidential Communications.
You may tell El Paso First where and how to send messages that includes health information, if you think sending the information to your usual address could put yourself in danger. For example, you may ask that El Paso First only communicate with you at a certain telephone number. You must put this request in writing, and you must be specific about where and how to contact you.

Right to a Paper Copy of this Notice.
You may ask for and get a paper copy of this Notice from El Paso First at any time, even if you have received this Notice previously or agreed to receive this Notice electronically. Right to Withdraw an Authorization for Disclosure. You may withdraw permission you have given El Paso First to use or disclose your health information, unless El Paso First has already taken action based on your permission. You must withdraw your permission in writing.

EL PASO FIRST'S DUTY TO PROTECT YOUR HEALTH INFORMATION

El Paso First is required by law to:

maintain the privacy of your health information as set forth in this Notice;

provide to you this Notice of its legal duties and privacy practices;

abide by the terms of this Notice, which may be amended from time to time;

notify you if we are unable to agree to a requested restriction regarding how your information is used or disclosed;

accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and

obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law.

In most situations, El Paso First may not use or disclose your health information without your written permission. This Notice explains when El Paso First may use or disclose your health information without your permission.

For all other uses and disclosures, El Paso First must obtain your written permission, which you may withdraw at any time.

El Paso First reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains. If El Paso First changes its privacy practices, it must notify you of the changes by mailing a new Notice of Privacy Practices to the most recent address you have given El Paso First. El Paso First will mail the new Privacy Notice within 60 days of the changes. The new practices will apply to all the health information El Paso First has about you, regardless of when El Paso First received or created the information.

El Paso First employees must protect the privacy of your health information. El Paso First does not give employees access to health information unless they need it to do their job. Reasons for needing access to health information include making benefit decisions, paying bills, and planning for the care needed. El Paso First will punish employees who do not protect the privacy of your health information.

If you have questions about this Notice, need an additional copy of this Notice, or need more information about your privacy rights, you may contact the following:

Privacy Officer at 915-532-3778 or 1-877-532-3778 if outside the local calling area.

COMPLAINTS
If you believe El Paso First has violated your privacy rights, you may file a complaint by contacting El Paso First's Privacy Officer at 915-532-3778. You may also file a complaint with the Department of Health & Human Services.

El Paso First encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a compliant.

HOW EL PASO FIRST MAY USE OR DISCLOSE YOUR HEALTH CARE INFORMATION
1. To Make or Obtain Payment
El Paso First may use or disclose your health information in order to make payment to or to collect payment from third parties. For example, El Paso First may provide information regarding your coverage or health care treatment to other health care plans to coordinate payment of benefits. Also, El Paso First may review the health care services that were provided with respect to medical necessity, coverage under health plan, appropriateness of care, or justification of charges.

2. To Conduct Health Care Operations
El Paso First may use or disclose your health information for its own operations and as necessary to provide coverage and services to all of El Paso First's members. Health care operations include such activities as: · conducting quality assessment and improvement activities;

performing activities designed to improve health or reduce health care costs;

researching information for resolution of complaints and grievances;

reviewing the competence, qualifications, and performance of physicians who provide your care; and

engaging in business management or the general administrative activities of El Paso First.
Examples of uses and disclosures for health care operations include using or disclosing health information for case management or making sure providers bill only for care you receive. El Paso First may also contact you to tell you about treatment alternatives or additional benefits you may be interested in.

3. Family Member, Other Relative, or Close Personal Friend
El Paso First may disclose your health information to a family member, other relative, or close personal friend if:

the health information is related to that person's involvement with your care or payment for your care; and

you have had an opportunity to stop or limit the disclosure before it happens.

4. Government Programs Providing Public Benefits
El Paso First may disclose your health information to another government agency offering public benefits if:

the information relates to whether you qualify for or are enrolled in a government-funded health care program and the law requires or specifically allows the disclosure; or

the other government agency has the same privacy protections the government funded program does, has programs that serve similar types of people, and the disclosure is needed to coordinate or improve how the programs are run.

5. Health Oversight Activities
El Paso First may use or disclose your health information to a health oversight agency for authorized activities including audits, civil administration or criminal investigations, inspections, licensure or disciplinary action. Health oversight activities include investigating possible fraud in any government-funded program.

6. Public Health
El Paso First may disclose your health information for public health activities, including to:

a public health authority to prevent or control disease, injury, or disability; and

a government agency authorized to receive reports of child abuse or neglect or reports of domestic violence.

7. Serious Threat to Health or Safety
El Paso First may use or disclose your health information if it believes the use or disclosure is needed:

to prevent or lessen a serious and immediate threat to the health and safety of a person or the public;

for law enforcement authorities to identify or catch an individual who has admitted participating in a violent crime that resulted in serious physical harm to the victim, unless the information was learned while initiating or in the course of counseling or therapy; or

for law enforcement authorities to catch an individual who has escaped from lawful custody.

8. For Other Law Enforcement Purposes
El Paso First may disclose your health information to a law enforcement official for the following law enforcement purposes, including:

to comply with a subpoena;

to comply with a lawful administrative request;

to identify and locate a suspect, fugitive, witness, or missing person;

in an emergency to report a crime;

in response to a request for information about an actual or suspected victim of a crime; or

to alert a law enforcement official of a death that El Paso First suspects is the result of criminal conduct.

9. For Judicial or Administrative Proceedings
El Paso First may disclose your health information for judicial and administrative purposes, including:

an order from a regular or administrative court; or

in response to a subpoena, discovery request or other lawful process.

10. As Required By Law
El Paso First must use and disclose your health information when a law requires the use or disclosure. For example, El Paso First may disclose information for the following purposes:

for report information related to victims of abuse, neglect or domestic violence;

for judicial and administrative proceedings pursuant to legal authority; and

to assist law enforcement officials in their law enforcement duties.

11. Contractors
El Paso First may disclose your health information to an El Paso First contractor if the contractor:

needs the information to perform services for El Paso First; and

agrees in writing by a contract to protect the privacy of the health information.

12. Secretary of Health and Human Services
El Paso First must disclose your health information to the Secretary of Health and Human Services when the Secretary wants it to enforce privacy protections.

13. Research
El Paso First may use or disclose your health information for research purposes if an institutional research board or a privacy board that has reviewed the research proposal and established protocols to ensure the privacy ofyour health information has approved the research. The board will ensure that your privacy is protected when your health information is used in research. Uses and disclosures for research include:

to allow a researcher to prepare a research project, as long as the researcher agrees to keep the information confidential; and

research on your health information, if you die.

14. Worker's Compensation
El Paso First may release your health information to the extent necessary to comply with laws related to worker's compensation or similar programs.

15. Disclosure to the Plan Sponsor
If applicable, El Paso First may disclose your health information to the plan sponsor for plan administration functions performed by the plan sponsor on behalf of El Paso First. El Paso First may also provide a summary of health information to the plan sponsor so that the plan sponsor may solicit premium bids from other health plans or modify, amend or terminate the plan.

16. Other uses and disclosures
El Paso First may use or disclose your health information:

to create health information that does not identify any specific individual;

for purposes of lawful national security activities;

to federal officials to protect the President and others;

to a prison or jail, if you are an inmate of that prison or jail, or to law enforcement personnel if you are in custody; and

to tell or help in telling a family member or another person involved in your care about your location, general condition, or death.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

Other than as stated above, El Paso First will not disclose your health information other than with your written authorization. If you authorize El Paso First to use or disclose your health information, you may revoke that authorization in writing at any time.

EFFECTIVE DATE
This Notice takes effect on April 14, 2003, and stays in effect until it is replaced by another Notice.

CONTACT INFORMATION
If you have any questions or complaints, please contact:

El Paso First Health Plan, Inc.
Attn: Privacy Officer
1145 Westmoreland Drive
El Paso, Texas 79925
Phone: 915-532-3778
Fax: 915-532-2877

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