We want to provide all of our clients with the most up to date information on every detail to their plan. With this in mind, please refer to all disclaimers listed below in order to ensure you of the highest possible customer service possible.
Notice of Privacy Practices Health New England Inc.
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.
Health New England ("HNE") knows how important it is to protect your privacy at all times and in all settings. We are required by law to maintain the privacy of your protected health information (PHI), to provide you with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected
individuals following a breach of unsecured protected health information.
“Protected health information” or “PHI” is information about you, including demographic information,
- Can reasonably be used to identify you; and
- That relates to your past, present or future physical or mental health or condition, the provision
of health care to you or the payment for that care.
Protected health information excludes individually identifiable health information regarding a person
who has been deceased for more than 50 years.
How does Health New England collect protected health information?
HNE gets PHI from:
- Information we receive directly or indirectly from you, your employer or benefits plan sponsor
through applications, surveys, or other forms. For example: name, address, social security
number, date of birth, marital status, dependent information and employment information.
- Providers (such as doctors and hospitals) who are treating you or who are involved in your
treatment and/or their staff when they submit claims or request authorization on your behalf for
certain services or procedures.
- Attorneys who are representing our Members in automobile accidents or other cases.
- Insurers and other health plans.
How does HNE protect my personal health information?
HNE has many physical, electronic, and procedural safeguards in place to protect your information.
Information is protected whether it is in oral, written or electronic form. HNE policies and procedures
require all HNE employees to protect the confidentiality of your PHI. An employee may only access
your PHI when they have an appropriate reason to do so. Each employee must sign a statement that he
employees to remind them of this policy. Any employee who violates HNE’s privacy policies is subject
to discipline, up to and including dismissal.
How does HNE use and disclose my protected health information?
HNE uses and discloses your PHI for many different reasons. We can use or disclose your PHI for some
reasons without your written agreement. For other reasons, we need you to agree in writing that we can
use or disclose your PHI.
Uses and Disclosures for Treatment, Payment and Health Care Operations
HNE uses and discloses your PHI in a number of different ways in connection with your treatment, the
payment for your health care, and our health care operations. We can also disclose your information to
providers and other health plans that have a relationship with you, for their treatment, payment and some
limited health care operations. The following are only a few examples of the types of uses and
disclosures of your protected health information that we are permitted to make without your
Treatment: We may disclose your protected health information to health care providers (doctors,
dentists, pharmacies, hospitals and other caregivers) who request it in connection with your treatment.
We may also disclose your protected health information to health care providers (including their
employees or business associates) in connection with preventive health, early detection and disease and
case management programs.
Payment: We will use and disclose your protected health information to administer your health benefits
policy or contract. For example, we may use your PHI to pay claims for medical services you have
received, to determine your eligibility for benefits, or to coordinate your HNE coverage with that of
other plans (if you have coverage through more than one plan).
Health Care Operations: We will use and disclose your protected health information to support HNE’s
general health care operations. For example, we may use your PHI to conduct quality assessment
activities, develop clinical guidelines, operate preventive health, early detection and disease and case
management programs, including contacting you or your doctors to provide appointment reminders or
information about treatment alternatives, therapies, health care providers, settings of care or other
health-related benefits and services. In addition, we may use your information to send fundraising
communications to you. If we do, we will provide you with an opportunity to elect not to receive any
further fundraising communications from us.
HNE does not and will not use PHI that is genetic information about you for underwriting purposes.
Other Permitted or Required Uses and Disclosures of Protected Health Information
In addition to treatment, payment and health care operations, federal law allows or requires us to use or
disclose your protected health information in the following additional situations without your
Required by Law: We may use or disclose your protected health information to the extent we are
required by law to do so. For example, the law compels us to disclose PHI when required by the
Secretary of the Department of Health and Human Services to investigate our compliance efforts.
Public Health Activities: We may disclose your protected health information to an authorized public
health authority for purposes of public health activities. The information may be disclosed for such
reasons as controlling disease, injury or disability, or to report child abuse or neglect. We also may have
to disclose your PHI to a person who may have been exposed to a communicable disease or who may
otherwise be at risk of contracting or spreading the disease. In addition, we may make disclosures to a
person subject to the jurisdiction of the Food and Drug Administration, for the purpose of activities
related to the quality, safety or effectiveness of an FDA-regulated product or activity.
Abuse or Neglect: We may make disclosures to government authorities if we believe you have been a
victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when
we are required or authorized by law to do so.
Health Oversight: We may disclose your protected health information to a government agency
authorized to oversee the health care system or government programs, or its contractors (e.g., state
insurance department, U.S. Department of Labor) for activities authorized by law, such as audits,
examinations, investigations, inspections and licensure activity.
Legal Proceedings: We may disclose your protected health information in the course of any judicial or
administrative proceeding, in response to an order of a court or administrative tribunal and, in certain
cases, in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may disclose your protected health information under limited circumstances to
law enforcement officials. For example, disclosures may be made in response to a warrant or subpoena
or for the purpose of identifying or locating a suspect, witness or missing persons or to provide
information concerning victims of crimes.
Coroners, Funeral Directors and Organ Donation: We may disclose your protected health information
in certain instances to coroners, funeral directors and organizations that help find organs, eyes, and
tissue to be donated or transplanted.
Threat to Health or Safety: If we believe that a serious threat exists to your health or safety, or to the
health and safety of any other person or the public, we will notify those persons we believe would be
able to help prevent or reduce the threat.
Military Activity and National Security: We may disclose your protected health information to Armed
Forces personnel under certain circumstances and to authorized federal officials for the conduct of
national security and intelligence activities.
Correctional Institutions: If you are an inmate in a correctional facility, we may disclose your protected
health information to the correctional facility for certain purposes, including the provision of health care
to you or the health and safety of you or others.
Workers’ Compensation: We may disclose your protected health information to the extent required by
workers’ compensation laws.
Research: We may use or disclose PHI for research provided certain requirements are met.
Will HNE give my PHI to my family or friends?
We will only disclose your PHI to a family member or a close friend in the following circumstances:
- You have authorized us to do so.
- That person has submitted proof of legal authority to act on your behalf.
- That person is involved in your health care or payment for your health care and needs your PHI
for these purposes. If you are present or otherwise available prior to such a disclosure (whether
in person or on a telephone call), we will either seek your verbal agreement to the disclosure,
provide you an opportunity to object to it, or reasonably infer from the circumstances, based on
our exercise of professional judgment, that you would not object to the disclosure. We will
only release the PHI that is directly relevant to their involvement.
- We may share your PHI with your friends or family members if professional judgment says
that doing so is in your best interest. We will only do this if you are not present or you are
unable to make health care decisions for yourself. For example, if you are unconscious and a
friend is with you, we may share your PHI with your friend so you can receive care.
- We may disclose a minor child’s PHI to their parent or guardian. However, we may be
required to deny a parent’s access to a minor’s PHI, for example, if the minor is an
emancipated minor or can, under law, consent to their own health care treatment.
- If an individual is deceased, we may disclose to a family member or friend who was involved
in the individual’s care or payment for care prior to the individual’s death, PHI of the
individual that is relevant to such person’s involvement, unless doing so is inconsistent with
any prior expressed preference of the individual that is known to us.
Will HNE disclose my personal health information to anyone outside of HNE?
HNE may share your protected health information with affiliates and third party “business associates”
that perform various activities for us or on our behalf. For example, HNE may delegate certain
functions, such as medical management or claims repricing, to a third party that is not affiliated with
HNE may also share your personal health information with an individual or company that is
working as a contractor or consultant for HNE. HNE’s financial auditors may review claims or other
confidential data in connection with their services. A contractor or consultant may have access to such
data when they repair or maintain HNE’s computer systems. Whenever such an arrangement involves
the use or disclosure of your protected health information, we will have a written contract that contains
terms designed to protect the privacy of your protected health information.
HNE may also disclose information about you to your Primary Care Provider, other providers that treat
you and other health plans that have a relationship with you, and their business associates, for their
treatment, payment and some of their health care operations.
Will HNE disclose my personal health information to my employer?
In general, HNE will only release to your employer enrollment and disenrollment information,
information that has been de-identified so that your employer can not identify you, or summary health
information. If your employer would like more specific PHI about you to perform plan administration
functions, we will either get your written permission or we will ask your employer to certify that they
have established procedures in their group health plan for protecting your PHI, and they agree that they
will not use or disclose the information for employment-related actions and decisions. Talk to your
employer to get more details.
When does HNE need my written authorization to use or disclose my personal health information?
We have described in the preceding paragraphs those uses and disclosures of your information that we
may make either as permitted or required by law or otherwise without your written authorization. For
other uses and disclosures of your PHI, we must obtain your written authorization. Among other things,
a written authorization request will specify the purpose of the requested disclosure, the persons or class
of persons to whom the information may be given, and an expiration date for the authorization. If you do
provide a written authorization, you generally have the right to revoke it.
Your prior written authorization is required and will be obtained for: (i) uses and disclosures of
psychotherapy notes; (ii) uses and disclosures of PHI for marketing purposes, including subsidized
treatment communications; (iii) disclosures that constitute a sale of PHI; and (iv) other uses and
disclosures not described in this Notice of Privacy Practices.
Many Members ask us to disclose their protected health information to third parties for reasons not
described in this notice. For example, elderly Members often ask us to make their records available to
caregivers. To authorize us to disclose any of your protected health information to a person or
organization for reasons other than those described in this notice, please call our Member Services
Department and ask for an Authorization and Designation of Personal Representative Form. You should
return the completed form to HNE’s Enrollment Department at One Monarch Place, Springfield, MA
01144-1500. You may revoke the authorization at any time by sending us a letter to the same address.
Please include your name, address, Member identification number and a telephone number where we
can reach you.
What are my rights with respect to my PHI?
The following is a brief statement of your rights with respect to your protected health information:
Right to Request Restrictions: You have the right to ask us to place restrictions on the way we use or
disclose your protected health information for treatment, payment or health care operations or to others
involved in your health care. However, we are not required to agree to these restrictions. If we do
agree to a restriction, we may not use or disclose your protected health information in violation of that
restriction, unless it is needed for an emergency.
Right to Request Confidential Communications:
You have the right to request to receive
communications of protected health information from us by alternative means or at alternative locations
if you clearly state that the disclosure of all or part of that information could endanger you. We will
accommodate reasonable requests. Your request must be in writing.
Right to Access Your Protected Health Information:
You have the right to see and get a copy of the
protected health information about you that is contained in a “designated record set,” with some specified exceptions. You also have the right to request an electronic copy of PHI that we maintain
electronically (ePHI) in one or more designated records sets. Your “designated record set” includes
enrollment, payment, claims adjudication, case or medical management records and any other records
that we use to make decisions about you. Requests for access to copies of your records must be in
writing and sent to the attention of the HNE Legal Department. Please provide us with the specific
information we need to fulfill your request. We will provide ePHI in the electronic form and format
requested by you, if it is readily producible in that format. We reserve the right to charge a reasonable
fee for the cost of producing and mailing the copies.
Right to Amend Your Protected Health Information: You have the right to ask us to amend any
protected health information about you that is contained in a “designated record set” (see above). All
requests for amendment must be in writing and on an HNE Request for Amendment form. Please
contact the HNE Legal Department to obtain a copy of the form. You also must provide a reason to
support the requested amendment. In certain cases, we may deny your request. For example, we may
deny a request if we did not create the information, as is often the case for medical information in our
records. All denials will be made in writing. You may respond by filing a written statement of
disagreement with us, and we would have the right to rebut that statement. If you believe someone has
received the unamended protected health information from us, you should inform us at the time of the
request if you want them to be informed of the amendment.
Right to Request an Accounting of Certain Disclosures: You have the right to have us provide you an
accounting of times when we have disclosed your protected health information for any purpose other
than the following:
(i) Treatment, payment or health care operations.
(ii) Disclosures to others involved in your health care.
(iii)Disclosures to you or that you or your personal representative has authorized.
(iv)Certain other disclosures, such as disclosures for national security purposes.
All requests for an accounting must be in writing. We will require you to provide us the specific
information we need to fulfill your request. This accounting requirement applies for six years from the
date of the disclosure, beginning with disclosures occurring after April 14, 2003. If you request this
accounting more than once in a 12-month period, we may charge you a reasonable fee.
Right to Request a Copy of this Notice: If you have received this notice electronically, you have the
right to obtain a paper copy of this notice upon request.
Who should I contact if I have a question about this notice or a complaint about how HNE is using my
personal health information?
Complaints and Communications with Us
If you want to exercise your rights under this Notice, communicate with us about privacy issues, or if
you wish to file a complaint with us, you can write to:
Health New England, Inc.
Complaints and Appeals Department
One Monarch Place
Springfield, MA 01144-1500
You can also call us at 413.787.4004 or 800.310.2835. You will not be retaliated against for filing a
complaint with us.
Complaints to the Federal Government
If you believe your privacy rights have been violated, you also have the right to file a complaint with the
Secretary of the Department of Health and Human Services. You will not be retaliated against for filing
a complaint with the federal government.
Effective Date of Notice
This Notice takes effect on July 1, 2013. We must follow the privacy practices described in this Notice
while it is in effect. This Notice will remain in effect until we change it. This Notice replaces any other
information you have previously received from us with respect to privacy of your medical information.
Changes to This Notice of Privacy Practice
We may change the terms of this Notice at any time in the future and make the new Notice effective for
all PHI that we maintain—whether created or received before or after the effective date of the new
Notice. Whenever we make an important change, we will post the change or the revised Notice on our
web site by the effective date of the material change to the Notice, and provide the revised Notice, or
information about the material change and how to obtain the revised Notice, in our next annual mailing
to individuals then covered by the plan.