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.
If you have any questions about this notice, please contact Missouri Consolidated Health Care Plan's Privacy Officer at 832 Weathered Rock Court, PO Box 104355, Jefferson City, MO 65110, or by calling 573-751-8881 or toll-free 800-701-8881.
This notice describes the privacy practices followed by work force members of Missouri Consolidated Health Care Plan. For purposes of this notice, the pronouns "we," "us" and "our" and the acronym "MCHCP" refer to Missouri Consolidated Health Care Plan.
This notice applies to the information and records we have about your health care and the services you receive. We are required by law to maintain the privacy of your protected health information and to notify you if there has been a breach of your protected health information. We are also required by law to give you this notice. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.
For Treatment: We may use health information about you to assist in providing you with medical treatment or services. For example, we may use and disclose protected health information with your providers (pharmacies, physicians, hospitals, etc.) to assist in your treatment.
For Payment: We may use and disclose protected health information about you so that the treatment and services you receive will be paid. For example, we may use or disclose protected health information in order for your claims to be processed, coordinate your benefits, review health care services provided to you and evaluate medical necessity or appropriateness of care or charges. We may also use or disclose your protected health information to determine whether a treatment is a covered benefit under the health plan. We may use and disclose your protected health information to determine eligibility for coverage, in order to obtain pre-tax payment of your premiums from your employer or sponsoring entity, and for determining wellness premium incentives. We may use and disclose your protected health information for underwriting purposes, but, if we do, we are prohibited from using your genetic information for such purposes.
For Health Care Operations: We may use and disclose protected health information for our health care operations. For example, we may use and disclose your protected health information to address or resolve complaints or appeals regarding your medical benefits. We may use or disclose protected health information with our wellness or disease management programs in which you participate. We may use your protected health information to conduct audits, for purposes of rate-making, as well as for purposes of risk management. We may also disclose your protected health information to our attorneys, accountants and other consultants who assist us in performing our functions. We may disclose your protected health information to health care providers or entities for certain health care operations activities, such as quality assessment and improvement activities, case management and care coordination. In this case, we will only disclose your protected health information to these entities if they have or have had a relationship with you and your protected health information pertains to that relationship, such as with other health plans or insurance carriers in order to coordinate benefits, if you or your family members have coverage through another health plan.
Disclosures to Employer: We may also use and disclose protected health information with your employer as necessary to perform administrative functions. Employers who receive this type of information are required by law to have safeguards in place to protect against inappropriate use or disclosure of your information.
Disclosures to Family Members or Others: We may disclose health information about you to your family members or friends if we obtain your written authorization to do so. Also, unless you object, we may disclose relevant portions of your protected health information to a family member, friend or other person you indicate is involved in your health care or in helping you receive payment for your health care. For example, we may assume you agree to our disclosure of your personal health information to your spouse when you bring your spouse with you to a meeting or have your spouse on the telephone while such information is discussed. We may also disclose claim and payment information of family members to the subscriber in a family plan.
If you are not capable of agreeing or objecting to these disclosures because of, for instance, an emergency situation, we will disclose protected health information (as we determine) in your best interest. After the emergency, we will give you the opportunity to object to future disclosures to family and friends.
Disclosures to Business Associates: We contract with individuals and entities (business associates) to perform various functions on our behalf or provide certain types of services. To perform these functions or provide these services, our business associates will receive, create, maintain, use or disclose protected health information. We require the business associates to agree in writing to contract terms to safeguard your information, consistent with federal and state law. For example, we may disclose your protected health information to a business associate to administer claims or provide service support, utilization management, subrogation or pharmacy benefit management.
We may use or disclose health information about you without your permission for the following purposes, subject to all applicable legal requirements and limitations:
We will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific, written authorization. If you give us authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose information about you for the reasons covered by your written authorization, but we cannot take back any uses or disclosures already made with your permission.
If we have HIV or substance abuse information about you, we cannot release that information without a special signed, written authorization from you. In order to disclose these types of records for purposes of treatment, payment or health care operations, we will have to have both your signed consent and a special written authorization that complies with the law governing HIV or substance abuse records.
If you have psychotherapy notes, we will not use or disclose that information without authorization unless the use or disclosure is used to defend MCHCP in a legal action or other proceeding brought by you.
MCHCP will not use or disclose your protected health information for marketing purposes without an authorization, except if the marketing communication is in the form of a face-to-face communication made by MCHCP to you or in the form of a promotional gift of nominal value provided by MCHCP. MCHCP will not sell your protected health information without your authorization.
You have the following rights regarding health information we maintain about you:
MCHCP is required to abide by the terms of the notice currently in effect. We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you, as well as any information we receive in the future. We will post the revised notice to our website prior to the effective date of the change, and we will distribute any amended notice or information about the change and how to obtain a revised notice in the next annual communication to members, either by mail or electronically if you have agreed to receive communication in that manner. Please note that the amended notice may be part of another mailing from MCHCP. In addition, we will post a summary of the current notice in our office and on this website with its effective date directly under the heading. You are entitled to a copy of the notice currently in effect.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the federal office of the Secretary of the Department of Health and Human Services - Office of Civil Rights. To file a complaint with our office, contact MCHCP’s Privacy Officer at 573-751-8881 or toll-free 800-701-8881. You will not be penalized or retaliated against for filing a complaint.
You may contact the Department of Health and Human Services on your rights under HIPAA at:
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