Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Delta Dental is required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information. We are committed to protecting your health information. This notice is effective on the date your group coverage went into effect.
Our Collection Practices
We can and do collect individually identifiable information in connection with your dental services program and we may use such information in making decisions associated with your dental services program. This information is collected from your application, group enrollment form, claims submitted by you or your dentist, direct personal contact, correspondence, telephone, facsimile or electronic communications.
Uses and Disclosures of Protected Health Information
In almost all cases, we may use and disclose protected health information (PHI) for treatment, payment and health care operations such as:
- To communicate with the dentist who provides, coordinates, or manages your care,
- To determine how much or whom we should pay for covered services,
- To assist another Delta Dental plan with your claims for out-of-state services,
- To coordinate benefits with an insurance carrier that provides you the same or similar benefits,
- To assess the quality of care that our participating dentists provide, and
- For case management or to direct or recommend alternative treatments, therapies, providers or provider locations.
In addition, we may use or disclose protected health care information to individuals and entities for the purposes described below:
- To you. We may use and disclose your PHI to communicate with you for purposes of customer service or to provide you with information you request. We may use and disclose information about you for the access and disclosure accounting purposes described in the “Your Rights” section of this notice.
- To your family and friends. We may disclose your PHI to a family member, friend or any other person you identify as being involved in your health care or payment for your health care if you agree in advance to the disclosure or we reasonably infer from the circumstances that you do not object to the disclosure. We may also disclose information about you to one of these people if you are not present or if you are unable to provide the required permission because of a medical emergency, accident or similar situation and we determine that disclosure would be in your best interests. In these situations, we may disclose only the PHI directly relevant to the person’s involvement with your health care or payment for health care. We may also disclose your PHI to anyone based on your written authorization (see last paragraph of this section).
- To your employer or other plan sponsor. In limited circumstances, we may disclose PHI to your employer (or other sponsor of your group dental plan). Specifically, we may disclose to your employer (or other plan sponsor) information about whether you are enrolled in the group health plan. We may disclose summary health information to your employer (or other plan sponsor) for the purpose of responding to a request for a dental services program proposal or to modify, amend or replace your dental services coverage. If your employer (or other plan sponsor) agrees to meet Federal privacy standards, we may disclose more detailed information to the employer (or other plan sponsor) for purposes of administering plan benefits. Please ask your employer (or other plan sponsor)for a more complete explanation of its uses and disclosures of PHI.
- For underwriting, enrollment and similar activities. We may receive PHI from you, your insurance agent, your plan sponsor’s health benefits consultant or other sources and use or disclose that information for purposes of underwriting, enrollment and other activities related to creating, renewing or replacing a benefits plan. We may not, however, use or disclose genetic information for underwriting purposes.
- For research. We may use or disclose PHI for research studies that meet all privacy law requirements.
- For public health and safety. We may use and disclose PHI to the extent necessary to avert a serious and imminent threat to your health or safety, or the health and safety of others. We may disclose PHI to a government agency (or its contractors) authorized to oversee the health care system or government programs, and to public health authorities for public health purposes. We may disclose PHI to appropriate authorities if we reasonably believe a member might be a victim of crime, domestic violence, abuse, or neglect.
- Required by law. We may use or disclose PHI to the extent required by law. For example, we may disclose your PHI to the U.S. Department of Health and Human Services if the department requests information to determine whether we are complying with federal privacy laws. In addition, we may disclose PHI to state insurance and health regulatory authorities conducting state insurance or health examinations or when responding to a complaint that you have filed with these or similar government agencies.
- Legal proceedings and other processes. We may disclose PHI in response to a court or administrative order, subpoena, discovery request, garnishment, or other lawful proceeding when we meet applicable privacy requirements. We may disclose PHI to a coroner or medical examiner as necessary to perform duties authorized by law. We may also disclose PHI when authorized by workers compensation or similar laws and regulations.
- Law enforcement. We may disclose PHI for law enforcement purposes. For example, we may disclose specific information about a suspect, fugitive, material witness, crime victim or missing person.
- Military and national security. We may disclose PHI to military or other government officials for certain purposes required or permitted by law. For example, we may disclose PHI to authorized officers for lawful intelligence, counter-intelligence, and other national security activities. Except as described in this notice, we may not use or disclose your PHI without your written authorization.
You may give us written authorization to use your PHI or to disclose it to anyone for any purpose. If you give us written authorization, you may revoke it at any time by notifying us of your revocation in writing. Your revocation will not affect any use or disclosure permitted by the authorization while it was in effect. We need your written authorization to use or disclose psychotherapy notes, except in limited circumstances such as when the disclosure is required by law. In most circumstances, we also must obtain your written authorization to sell information about you to a third party or to use or disclose your PHI to send you communications about products and services.
We do not need your written authorization, however, to send you communications about health related products or services, as long as the products or services are associated with your coverage or are offered by us.
Delta Dental of Colorado believes in a subscriber’s right to privacy with regard to his/her dental services plan records and dental history. We support an individual’s right to access his/her records and information in our possession pertaining to claims submitted for care and services. In accordance with current federal and state regulations, we strive to protect this information and allow access to personal information to the limited extent necessary for treatment purposes, patient knowledge, claim processing, and as otherwise permitted or required by law.
Request restriction of uses and disclosures of your PHI
You may request that we place additional restrictions on our use or disclosure of your PHI. We are not required to agree to your request for additional restrictions. If we do agree, however, we will abide by our agreement, except in situations in which the restricted information is necessary for emergency treatment. To be effective, our agreement to further restrictions must be in writing and signed by our Privacy Officer. We may terminate an agreement to further restrictions if we inform you of our termination. The termination will be effective for information created or received after we have informed you of our termination. Contact our Privacy Officer for more information about making a restriction request — see the contact information at the end of this notice.
Receive confidential communications about your PHI
You may request that we communicate with you confidentially about your PHI by using alternative means or an alternative location for those communications. You must make the request in writing and direct it to the Privacy Officer identified at the end of this notice. We do not have to agree to your confidential communications request unless you advise us in your written request that the current means and location of communication endangers you. We will accommodate your request if it is reasonable, specifies the alternative means or location, and permits us to collect premiums and pay claims required by your dental services plan.
Access your PHI
You have a right to inspect and obtain a copy of your PHI that we maintain in a designated record set (limited exceptions apply). You may designate another person to receive a copy of this information. You must make your request in writing and send it to the Privacy Officer listed at the end of this notice. We may charge a reasonable cost-based fee for copies (in any format) of your PHI that we provide.
Amend your PHI
You have the right to ask us to amend PHI about you for as long as we maintain the PHI in a designated record set. You must make the request in writing; direct your request to the Privacy Officer listed at the end of this notice, and explain why we should amend your information. We may deny your request for amendment if (a) we believe the information is accurate and complete, (b) we did not create the PHI that you wish to have amended, or (c) for other reasons permitted by law. If we deny your request, you may ask us to include a statement of disagreement in your records.
Request an accounting of disclosures of your PHI
You have a right to receive information about instances in which we (or our business partners) have disclosed your PHI for relatively uncommon purposes, such as for law enforcement or judicial proceedings. We will not, however, account for disclosures we routinely make for purposes such as treatment, payment or health care operations. You must make your request in writing and direct it to the Privacy Officer identified at the end of this notice. We will provide an accounting of disclosures for up to six years prior to the date of your request. We will provide the first accounting in any 12-month period free of charge. We may impose a reasonable cost-based fee for any subsequent request for an accounting within the same 12-month period.
Receive printed notice of our privacy practices
You may request a copy of this notice at any time by contacting the Privacy Officer at the end of this notice or print a copy here.
Opt out of fundraising communications
Delta Dental does not intend to contact you to raise funds, but if it does engage in fundraising, you have the right to opt out of receiving any fundraising communications.
You have the right to be notified of a breach of unsecured protected health information. Delta Dental will provide you the date and description of the information disclosed. You will be notified who the information was disclosed to if we are able. You will be notified by mail within 30 days from the date that we discover the breach.
Federal and State privacy law requires us to make reasonable efforts to ensure the privacy of PHI that we maintain. We are required to provide this notice of our privacy practices, your rights and our duties with respect to PHI. We must provide you notice of a non-permitted use or disclosure of your unsecured PHI, if the security or privacy of your information has been compromised under applicable State and Federal standards. We will adhere to the privacy practices described in this notice while it is in effect. This notice takes effect April 10, 2013.
We reserve the right to change our privacy practices and the terms of this notice at any time. Any new terms of our notice will be effective for all PHI that we maintain, including PHI that we created or received before we make the changes.
Before we make any material change in our privacy practices, we will change this notice and post the new notice on our website. We will provide a copy of the new notice (or information about the material change and information about how to obtain the new notice) in our next annual mailing to subscribers who are then covered by one of our dental services plans.
We restrict access to personal information to our employees, consultants, and outside vendors who need to know the information to provide products and services to our subscribers. We maintain physical, electronic, and procedural safeguards that comply with federal and state laws to guard against non-permitted and unauthorized disclosures. If you have any questions about our procedures or information maintained about you, please contact us at the address below (be sure to include your name, address, and subscriber identification number).
Your Contact Person for Privacy Matters
For more information about our privacy practices, to exercise your rights under this notice or to file a complaint about a privacy matter, contact our Privacy Officer at:
Delta Dental of Colorado
Attention: Privacy Officer
PO Box 5468
Denver, CO 80217-5468