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.
This Notice gives you information required
by the privacy provisions of the Health Insurance
Portability and Accountability Act of 1996 and its
implementing regulations (HIPAA Privacy Rules)
about the duties and privacy practices of Liberty
National Life Insurance Company to protect the
privacy of your medical information that we
maintain as an issuer of health insurance policies
that provide medical care benefits.We sent
this Notice to you because our records show that we
provide health care benefits to you under an
individual or group health insurance policy that
provides medical care benefits.
This Notice applies to the designated
health care components of Liberty National Life
Insurance Company that use and disclose your
medical information to provide medical care
benefits to you under health insurance policies.We use the
terms health and health care in this Notice to
refer to the medical care benefits we provide to
you.This
Notice does not apply to the information that our
non-health care components maintain about you as an
issuer of life, disability, accident, indemnity or
any other non-health insurance policy.
THE EFFECTIVE DATE OF THIS NOTICE IS APRIL
14, 2003.We
are required to follow the terms of this Notice
until we replace it.We reserve the right to change the terms of
this Notice at any time.If we make
changes to this Notice, we will revise it and send
a new Notice to all persons to whom we are required
to give the new Notice.We reserve
the right to make the new changes apply to all your
medical information maintained by us before and
after the effective date of the new Notice.
Purposes for which We May Use or Disclose
Your Medical Information Without Your Consent or
Authorization
We may use and disclose your medical
information for the following purposes:
·Health
Care Providers’Treatment
Purposes.For
example, we may disclose your medical information
to your doctor, at the doctor’s request, for your
treatment by him.
·Payment.For
example, we may use or disclose your medical
information to collect premiums, to pay claims for
covered health care services or to provide
eligibility information to your doctor when you
receive treatment.We may also use and disclose your medical
information to another covered entity or health
care provider for the payment activities of the
entity that receives your medical information.
·Health
Care Operations.For
example, we may use or disclose your medical
information (i) to conduct quality assessment and
improvement activities, (ii) for underwriting,
premium rating, or other activities relating to the
creation, renewal or replacement of a contract of
health insurance, (iii) to authorize business
associates to perform data aggregation services,
(iv) to engage in care coordination or case
management, and (v) to manage, plan or develop our
business.We
may also disclose your medical information to
another covered entity for the limited health care
operations activities and health care fraud and
abuse compliance activities of the entity that
receives your medical information.
·Health
Services.We may use
your medical information to contact you to give you
information about treatment alternatives or other
health-related benefits and services that may be of
interest to you.We may disclose your medical information to
our business associates to assist us in these
activities.
·As
required by law.For
example, we must allow the U.S. Department of
Health and Human Services to audit our records.We may also
disclose your medical information as authorized by
and to the extent necessary to comply with workers’
compensation or other similar laws.
·To
Business Associates.We may
disclose your medical information to business
associates we hire to assist us.Each of our
business associates must agree in writing to ensure
the continuing confidentiality and security of your
medical information.
·To
Plan Sponsor.If we
provide health benefits to you under a group health
plan, we may disclose to the plan sponsor of your
group health plan, in summary form, claims history
and other similar information.Such
summary information does not disclose your name or
other distinguishing characteristics.We may also disclose to the plan sponsor the
fact that you are enrolled in, or disenrolled from
the group health plan.We may
disclose your medical information to the plan
sponsor for administrative functions that the plan
sponsor provides to the group health plan if the
plan sponsor agrees in writing to ensure the
continuing confidentiality and security of your
medical information.The plan sponsor must also agree not to use
or disclose your medical information for
employment-related activities or for any other
benefit or benefit plans of the plan sponsor.
We may also use and disclose your medical
information as follows:
·To
comply with legal proceedings, such as a court or
administrative order or subpoena.
·To
law enforcement officials for limited law
enforcement purposes.
·To
a family member, friend or other person, for the
purpose of helping you with your health care or
with payment for your health care, if you are in a
situation such as a medical emergency and you
cannot give your agreement to us to do this.
·To
your personal representatives appointed by you or
designated by applicable law.
·For
research purposes in limited circumstances.
·To
a coroner, medical examiner, or funeral director
about a deceased person.
·To
an organ procurement organization in limited
circumstances.
·To
avert a serious threat to your health or safety or
the health or safety of others.
·To
a governmental agency authorized to oversee the
health care system or government programs.
·To
federal officials for lawful intelligence,
counterintelligence and other national security
purposes.
·To
public health authorities for public health
purposes.
·To
appropriate military authorities, if you are a
member of the armed forces.
Potential Impact of State Law
In some situations, the HIPAA Privacy
Rules do not preempt (or take precedence over)
state privacy laws that give you greater privacy
protections.As
a result, the privacy laws of a particular state
might impose a privacy standard under which we will
be required to operate (for example, a state
privacy law relating to disclosures of medical
information of minors).
Uses and Disclosures with Your Permission
We will not use or disclose your medical
information for any other purposes unless you give
us your written authorization to do so. If you give
us written authorization to use or disclose your
medical information for a purpose that is not
described in this Notice, then, in most cases, you
may revoke it in writing at any time.Your
revocation will be effective for all your medical
information we maintain, unless we have taken
action in reliance on your authorization.
Your Rights
You may make a written request to us to do
one or more of the following concerning your
medical information that we maintain:
·To
put additional restrictions on our use and
disclosure of your medical information.We do not
have to agree to your request.
·To
communicate with you in confidence about your
medical information by a different means or at a
different location than we are currently doing.We do not have to agree to your request unless
such confidential communications are necessary to
avoid endangering you and your request continues to
allow us to collect premiums and pay claims.Your
request must specify the alternative means or
location.Even
though you requested that we communicate with you
in confidence, we may give subscribers cost
information.
·To
see and get copies of your medical information.In limited
cases, we do not have to agree to your request.
·To
correct your medical information.In some
cases, we do not have to agree to your request.
·To
receive a list of disclosures of your medical
information that we and our business associates
made for certain purposes for the last 6 years (but
not for disclosures before April 14, 2003).
·To
send you a paper copy of this Notice if you
received this Notice by email or on the Internet.
If you want to exercise any of these
rights described in this Notice, please contact the
Contact Office (below).We will
give you the necessary information and forms for
you to complete and return to the Contact Office.In some
cases, we may charge you a nominal, cost-based fee
to carry out your request.
Complaints
If you believe we have violated your
privacy rights, you have the right to complain to
us or to the Secretary of the U.S. Department of
Health and Human Services.You may file a complaint with us at our
Contact Office (below).We will not
retaliate against you if you choose to file a
complaint with us or with the U.S. Department of
Health and Human Services.
Contact Office
To request additional copies of this
Notice or to receive more information about our
privacy practices or your rights, please contact us
at the following Contact Office:
