• Make sure that medical information that identifies you is kept secret
• Give you Notice of our legal duties and privacy practices with respect to your medical information
• Follow the terms of this Notice as it is currently in effect. If we revise this Notice as long as it is currently in effect.

How will Scott and White Health Plan Use My Medical Information?

Your medical information may be used for the following purposes:

• Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a family member, other relative, or close personal friend who is involved in your medical care or payment for your treatment. If you are able and available to agree or object, we will give you the opportunity to do so prior to disclosing any information. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communicating with your family and others.
• Employer or Other Plan Sponsor. We may share your health information or summary health information with your employer or other sponsor of your group health plan for the purpose of responding to a request for a health services program proposal or to modify, amend, or replace your health services coverage. We may also disclose to your plan sponsor information about whether you have been enrolled, are participating, or are no longer enrolled in the group health plan. Please review your employer’s health plan documents for a complete explanation of uses and disclosures of protected health information.
• Underwriting, Enrollment and Similar Activities. We may use and disclose information to underwrite, rate, enroll, determine cost-sharing amounts, and renew or respond to a request about your health services program. While we may use and disclose your information for underwriting, we are prohibited from using or disclosing protected health information that is genetic information for this purpose.
• Disaster Relief Agency. We may disclose information about you to an entity assisting in a disaster relief effort so that your family can be notified about your location and general condition.
• Public Health Activities. Public Health Activities usually includes disease prevention; injury or disability; reporting births and deaths; reporting child abuse or neglect; reporting reactions to medications or product problems; notification of recalls; infectious disease control; notifying government authorities of suspected abuse, neglect, or domestic violence. We may disclose your information for these purposes as required by law or if you agree.
• As Required by Law. We may use and disclose information about you as required by law, subpoena, or other legal process.
• Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law such as audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
• Health Oversight Activities.We may disclose medical information to a health oversight agency for activities authorized by law such as audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
• Organ and Tissue Donation. We may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank to facilitate organ or tissue donation and transplantation.
• Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all individuals who received one medication with those who received another, for the same condition. All research projects, however, are subject to a special approval process. This special approval process requires an evaluation of the proposed research project and its use of medical information, and balances these research needs with our members’ need for privacy of their medical information. Before we use or disclose medical information for research, the project generally will have been approved through this special approval process. However, this special approval process is not required when we allow medical information about you to be reviewed by people who are preparing a research project and who want to look at information about patients with specific medical needs, so long as the medical information these people review does not leave the hospital.
• Treatment Alternatives, Health Related Benefits, and Services. We may use and disclose medical information to give you information about treatment alternatives or health-related benefits/services that may be of interest to you. You will have an opportunity to refuse to receive this information.
• Governmental Disclosures. SWHP may disclose health information: a) about Armed Forces personnel to military authorities under certain circumstances, b) as required for lawful intelligence, counterintelligence, and other national security activities to authorized federal officials, or c) about inmates to correctional institutions or law enforcement officials having lawful custody.
• Worker’s Compensation. Your medical information regarding benefits for worker-related illnesses may be released as appropriate.
• Student Immunizations to Schools. SWHP may disclose proof of your child’s immunizations to their school based on your verbal or written permission to do so.

Your Authorization Is Required for Other Disclosures

Except as described above, SWHP will not use or disclose your medical information unless you authorize (permit) doing so in writing.

There are certain uses and disclosures of your medical information that cannot be made unless you authorize or permit them in writing. These uses and disclosures include:

• Psychotherapy Notes
• Marketing Purposes
• Sale of Protected Health Information

You may revoke your authorization, which will be effective only after the date of receipt of your written revocation.

Patient Rights

You have the following rights regarding medical information we maintain about you:

• Right to Request Restriction. You may request limitations on your medical information we use or disclose for healthcare treatment, payment or operations, but we are not required to agree to your request unless you are requesting to restrict information from use and disclosure to your health plan when you have paid for a healthcare item or service out-of-pocket and in full. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment. To request restrictions you must contact SWHP Customer Advocacy at 1-254-298-3000 or 1-800-321-7947.
• Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you by telephone at work or that we only contact you by mail at home. Your request must specify how or where you wish to be contacted. To request confidential communications you must contact SWHP Customer Advocacy at 1-254-298-3000 or 1-800-321-7947. SWHP will not ask you the reason for your request. SWHP will accommodate all reasonable requests.
• Right to Request Amendment. If you believe that the medical information we have about you is incorrect or incomplete, you may request an amendment. SWHP is not required to accept the amendment. To request an amendment, you must contact SWHP Customer Advocacy at 1-254-298-3000 or 1-800-321-7947.
• Right to an Accounting of Disclosures. You may request a list of the disclosure of your medical information that have been made to persons or entities other than for treatment, payment or operations in the past six (6) years, but not prior to April 14, 2003. The first list you request within a twelve (12) month period will be free of charge. For additional lists, SWHP may charge you for the costs of providing the list. To request an accounting of disclosures, you must contact SWHP Customer Advocacy at 1-254-298-3000 or 1-800-321-7947.
• Right to Inspect and Copy. You have the right to inspect and receive a copy your medical information regarding decisions about your care, including medical and billing records. You may request copies of medical information in paper or electronic form. SWHP will make every effort to comply with your request. SWHP will charge a fee for copying, mailing and supplies. SWHP may deny your request to inspect and copy in certain very limited circumstances including inspection and copy of psychotherapy notes. You may request a review of the denial by another licensed healthcare professional chosen by SWHP. To inspect and receive a copy of your medical information call SWHP Customer Advocacy at 1-254-298-3000 or 1-800-321-7947.
• Right to a Breach Notification. You have the right to a notification from SWHP if you are affected by a breach of unsecured medical information. We will notify you formally and work to minimize any negative impact to you.
• Right to a Copy of this Notice. You have a right to receive a paper copy of the Notice of Privacy Practices upon request at any time and you may also view a copy of the Notice on our member web site at www.swhp.org.