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Notice of Privacy Practices

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FEDERATED MUTUAL INSURANCE COMPANY

HEALTH INSURANCE DIVISION

NOTICE OF PRIVACY PRACTICES

THIS NOTICE OF PRIVACY PRACTICES (“NOTICE”) DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED BY FEDERATED’S HEALTH INSURANCE DIVISION AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT OUR PRIVACY OFFICIAL. THIS PERSON MAY BE CONTACTED BY PHONE DURING NORMAL WORKING HOURS AT: (507)-455-5200 (ASK FOR PRIVACY OFFICIAL) OR BY MAIL AT 121 EAST PARK SQUARE, OWATONNA, MN 55060, ATTN: PRIVACY OFFICIAL.

In order for Federated to go about the business of providing health insurance, we must use and share Protected Health Information, both internally and with other businesses and health care providers.

“Protected Health Information” is defined by the HIPAA1 Privacy Rule2 as information that we have created or received in our capacity as a health insurer and that identifies you or your dependents or could be used to identify you or your dependents and that relates to the past, present or future physical or mental health condition of you or your dependents. It also includes information about the provision of care or the payment for that care.

Federated is required by the Privacy Rule to

  • Maintain the privacy of your Protected Health Information;
  • Give you this Notice of our legal duties and privacy practices with respect to your Protected Health Information; and
  • Follow the terms of the Notice that is currently in effect.

This Notice describes how we may use and disclose Protected Health Information (please note that not every possible use or disclosure within a category of uses or disclosures is included) and certain rights you have regarding the use and disclosure of your Protected Health Information.

  1. Federated’s Most Common Uses and Disclosures of Protected Health Information.
    1. Payment Activities.
      1. Benefits and Claims. Federated and our business associates will obtain and disclose Protected Health Information for purposes of billing, repricing, claims management and administration, review of health care and determining whether a service is “medically necessary”, as well as utilization review. We may also forward such information to another health plan, which may also have an obligation to process and pay claims on your behalf. For example, in order to receive payment, a provider must submit a claim with your Protected Health Information on it for services rendered. The claim is sent to our claims department in paper or electronic format. Federated staff must have the health information to process claims according to your plan benefits. We may send you an explanation of benefits regarding claims payments.
      2. Pre-Certification. Federated may use or disclose your Protected Health Information to authorize a pre-certification to obtain medical treatment or services. For example, if your doctor is recommending a hospitalization we may review your medical information before the admission occurs to make sure that it is covered under your plan.
      3. Grievances and Appeals. Federated may use or request Protected Health Information to investigate a grievance and/or appeal by collecting internal and external documentation. Protected Health Information is shared with an internal grievance/appeal committee, which will also review the Protected Health Information to determine benefits and coverage. Federated may also disclose Protected Health Information to an independent external review organization, as required by applicable law.
    2. Health Care Operations.
      1. Quality Improvement Activities. Federated may use, and disclose to others, your Protected Health Information as part of its quality improvement activities, including outcomes evaluation, claims auditing, and the development of clinical guidelines. For example, we may use Protected Health Information to review treatment and services, and to evaluate the performance of providers and/or health plan staff in caring for you. Federated may combine medical information about many members to decide what additional services might be offered, whether certain new treatments are effective, and what services may not be needed. We may disclose information to hospitals, clinics, doctors, nurses, technicians, medical students, and other group health partners for review and learning purposes.
      2. Our Business Management. Federated may use and disclose your Protected Health Information as necessary for our business management and development which includes development and improvement of payment methods and coverage, compliance, and other allowable functions.
      3. Underwriting and Premium Rating. We may use Protected Health Information we receive at the time of enrollment (including names, addresses, dates of birth, phone numbers, Social Security numbers, and medical information) for underwriting, pricing coverage, premium quotes, premium renewals, and other activities relating to the creation and renewal of health insurance contracts or securing or placing a contract for reinsurance for health care claims, including stop loss coverage. For example, we may use health information that you include in your initial health statement in order to establish a premium for your coverage.
      4. Customer Services. In order to assist you with any problems or questions, our customer service representatives may need to review your Protected Health Information. For example, you may call with questions regarding authorization requirements, claims processing questions, effective dates of coverage, other specific coverage questions, questions regarding payment for services, or coordination of coverage or subrogation. Providers may also contact us, on your behalf, to inquire about claim status, coverage or eligibility.
    3. Disclosures of Summary Health Information and Enrollment Data to Plan Sponsors. Federated may provide Summary Health Information3 about you and other group health plan participants to the sponsor of the group health plan in which you participate (the “Plan Sponsor”) so the Plan Sponsor can make decisions regarding changing or terminating the plan or to solicit bids from other insurers or HMOs. For example, Federated may provide summary claims information to a Plan Sponsor so that it can decide whether to change the benefits that are being provided to employees. Federated may also provide enrollment or disenrollment data to Plan Sponsors.
    4. Additional Disclosures of Protected Health Information to Plan Sponsors. We may release your Protected Health Information (in addition to Summary Health Information and enrollment and disenrollment data) to the Plan Sponsor if the Plan Sponsor amends the Plan Document to include the HIPAA Privacy compliance promises required by the Privacy Rule (including a promise by the Plan Sponsor not to use the Protected Health Information for employment purposes or for other employee benefit plan purposes) and certifies to us that it has amended the Plan Document to include the compliance promises required by the Privacy Rule.
    5. Providing Information to Members Regarding Health-Related Products or Services. Federated may, from time to time, use your Protected Health Information to determine whether you might be interested in or benefit from treatment alternatives or other health-related programs, products or services which may be available to you as a member of the health plan or a covered person. For example, we may use your Protected Health Information to identify whether you have a particular illness, and contact you to advise you that a disease management program to help you manage your illness is available to you as a member or covered person. We will not use your Protected Health Information to communicate with you about products or services which are not health-related without your written permission.
    6. Disclosures to Business Associates. Federated works with other companies and consultants which perform certain functions on our behalf or provide services to us. For example we work with outside attorneys, organizations to help us manage utilization or prescription drug usage, and other contracted services. Federated will amend contracts with our business associates to include certain promises to comply with Privacy Rule requirements as required by the Privacy Rule.
    7. Disclosures to Individuals Involved in Your Care or Payment for Your Care. Unless you object, Federated may release Protected Health Information about you to a family member, other relative, or a close personal friend of yours or any other person identified by you. We will disclose only Protected Health Information that is directly relevant to the person’s involvement with your health care or payment related to your health care.

  2. Other Possible Uses and Disclosures of Protected Health Information by Federated.

    In addition to the common uses and disclosures of Protected Health Information addressed above, Federated may use and disclose Protected Health Information without your permission for the following reasons permitted by the Privacy Rule:

    1. Uses and Disclosures Required By Law. We will use or disclose your Protected Health Information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
    2. Uses and Disclosures Related to Public Health. We may disclose your Protected Health Information to a public health authority, authorized by law to receive such information, for the purpose of preventing or controlling disease, injury, or disability. We may also disclose your Protected Health Information at the direction of a public health authority, to an official of a foreign government agency that is acting in collaboration with a public health authority.
    3. Uses and Disclosures Involving the Food and Drug Administration. We may disclose your Protected Health Information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, or biologic product deviations; to track products; to enable product recalls; to make repairs or replacements; or to conduct post marketing surveillance, as required.
    4. Disclosures About Victims of Abuse, Neglect or Domestic Violence. We may disclose Protected Health Information about an individual whom we reasonably believe to be a victim of abuse, neglect, or domestic violence to a government authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence, to the extent the disclosure is required by law and the disclosure complies with and is limited to the relevant requirements of such law.
    5. Disclosures Related to Health Oversight Activities. Federated may disclose Protected Health Information to a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, and other government regulatory programs and civil rights laws.
    6. Disclosures for Judicial and Administrative Proceedings. Federated may disclose Protected Health Information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal, but only to the extent expressly authorized by the order. We may also disclose Protected Health Information in response to a subpoena, discovery request, or other lawful process, that is not accompanied by an order of a court or administrative tribunal, under certain circumstances.
    7. Disclosures for Law Enforcement Purposes. Federated may disclose Protected Health Information for a law enforcement purpose to a law enforcement official, under certain circumstances, pursuant to legal process and as otherwise required by law. We may also disclose Protected Health Information to a law enforcement official if that information constitutes evidence of criminal conduct that occurred on Federated’s premises.
    8. Disclosures to Coroners, Funeral Directors and Organ Donation. Federated may disclose Protected Health Information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. Federated may also disclose Protected Health Information to organizations for the purpose of facilitating organ, eye or tissue donation and transplantation.
    9. Disclosures for Research. Federated may disclose your Protected Health Information to researchers when their research has been approved by an institutional review board or a privacy board (as defined in the Privacy Rule) that has reviewed the research proposal and established protocols that ensure the privacy of your Protected Health Information.
    10. Disclosures to Prevent Criminal Activity. Consistent with applicable federal and state laws, we may disclose your Protected Health Information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose Protected Health Information if it is necessary for law enforcement authorities to identify or apprehend an individual.
    11. Military Activity and National Security. When appropriate conditions apply, we may use or disclose Protected Health Information of individuals who are Armed Forces personnel for purposes deemed necessary by the appropriate authorities or for the purposes of the Veterans Administration determining whether you are eligible for benefits.
    12. Uses and Disclosures for Workers Compensation. Your Protected Health Information may be disclosed by us to workers compensation insurers, state administrators, employers, and other persons involved in workers compensation systems as authorized by workers compensation or similar programs required by law.

  3. Required Disclosures of Protected Health Information.

    We will disclose Protected Health Information to you in accordance with your right to access your Protected Health Information or to receive an accounting of disclosures of your Protected Health Information. (See below for information on the right to access Protected Health Information or to receive an accounting of disclosures.) We will also disclose Protected Health Information to the Department of Health and Human Services when required by that department to investigate or determine our compliance with the requirements of the Privacy Rule.

  4. Uses and Disclosures of Your Protected Health Information with Your Written Permission.

    All other uses and disclosures by us of your Protected Health Information not listed above will be made only with your written permission, called an authorization.

    You may revoke your authorization at any time, in writing, except to the extent that Federated has taken action in reliance upon it.     Also, if Federated obtained the authorization as a condition of providing you insurance coverage, then, even if you revoke your authorization, Federated may use or disclose your Protected Health Information with respect to a claim if Federated has the right to contest the claim under the policy or the policy itself under state or other law.

  5. Your Rights Regarding Your Protected Health Information.

    Following is a statement of your rights with respect to your Protected Health Information and a brief description of how you may exercise those rights.

    1. You have the right to request a restriction of your Protected Health Information. This means you may ask us to limit or not to use or disclose any part of your Protected Health Information for the purposes of payment, treatment or healthcare operations. You may also request that any part of your Protected Health Information not be disclosed to family members, friends or others who may be involved in your care or for notification purposes as described in this Notice. Federated is not required to agree to these requested restrictions. However, if Federated agrees we must honor the restrictions you request. To ask for a restriction, send a written request to Federated’s Privacy Officer at the address shown at the beginning of this Notice.
    2. You have the right to request confidential communications. This means you can ask that we communicate with you by alternative means or at alternative locations. We will accommodate such a request if it is reasonable and if you state, in writing, that disclosure of the information in the ordinary manner could endanger you . You must make such a request in writing to Federated’s Privacy Official at the address shown at the beginning of this Notice. Federated may refuse to accommodate your request if you have not provided information as to how payment, if applicable, will be handled and specify how or where you wish to be contacted.
    3. You have the right to access your Protected Health Information. This means you have the right to inspect and to obtain a copy of your own Protected Health Information in a designated record set. A designated record set might include information related to enrollment, payment, claims adjudication, and case or medical management. There are some situations where we can refuse to permit access or copying. For instance, psychotherapy notes and information compiled in reasonable anticipation of civil, criminal or administrative actions or proceedings. If you want to inspect or obtain copies of your Protected Health Information you must send us a written request, directed to Federated’s Privacy Official at the address shown at the beginning of this Notice. We will act on your request within 30 days after receipt of the request, or 60 days, if the record set is not maintained or accessible on-site. We may extend the deadline by an additional 30 days, if warranted. If we use this 30-day extension period we will notify you in writing of the reason for the delay and the date on which we expect to have the information to you. You will be required to pay for the reasonable costs, including labor, of any copying and postage. If we deny your request, we will send you a written explanation and instructions about how to get a review of our denial, if one is required.
    4. You have the right to an accounting of disclosures. This means that you can get a list of the disclosures Federated made after April 14, 2003, of your Protected Health Information, within the past six years (or a shorter period if you want). This list of disclosures excludes disclosures made to you or as part of Federated’s payment, treatment and healthcare operations, disclosures made pursuant to your authorization, or certain other disclosures specified in the Privacy Rule. Federated will provide your requested accounting within 60 days after receipt of the request. By law, we can have one 30-day extension of time if we notify you of the extension in writing, the reason(s) for the delay and the date by which you will receive the accounting. You are entitled to one such list in every 12 month period, without charge. If you want more frequent lists, you will have to pay a reasonable fee for them in advance. If you want an accounting, send a written request to Federated’s Privacy Officer at the address shown at the beginning of this Notice.
    5. You have the right to request amendment of your Protected Health Information. This means that you can request that Federated change or correct Protected Health Information that we maintain about you. All requests must be in writing and directed to Federated’s Privacy Official at the address shown at the beginning of this Notice. You must supply us with the reason that you are requesting the amendment. We may deny your request if we did not create the information or the record which you want amended and we will provide that denial in writing. We may also deny the request for other reasons, including our determination that the record is accurate and correct. We will act on your written request within 60 days after we receive the request. By law, we can have one 30-day extension of time if we notify you of the extension in writing, the reason(s) for the delay and the date by which we will complete our action on your request. If an amendment is made by us, we may also notify others who work with us and have copies of the uncorrected record, if we believe that such notification is necessary.
    6. You have the right to additional copies of this Notice. You may get additional copies of this Notice of Privacy Practices, upon request, regardless of whether you have already received one electronically or in hard copy. If you want additional paper copies, send a written request to Federated’s Privacy Officer at the address shown at the beginning of this Notice.

  6. Federated’s Changes to This Notice.

    Federated reserves the right to change this Notice at any time in compliance with and as allowed by law. If we change this Notice, the new privacy practices will apply to your Protected Health Information that we already have as well as to such information that we may generate or receive in the future. If we make any substantial changes to our Notice of Privacy Practices, we will distribute the amended Notice within 60 days of the revision.

  7. Complaints Regarding Violation of Privacy Rights or Practices.

    You may complain to Federated and to the Secretary of Health and Human Services if you believe your privacy rights have been violated. In order to file a complaint with Federated please send your complaint in writing to Federated’s Privacy Official at the address shown at the beginning of this Notice. Federated will not retaliate against you for filing a complaint.

  8. More Stringent State Privacy Laws.

    If state laws regulating your health information provide even greater privacy protections regarding the use or disclosure of your Protected Health Information or your rights related to that information, Federated will provide you with those greater protections and rights.

  9. Notice Effective Date.

    This Notice is effective on April 14, 2003. The effective date of any changes to this Notice will be located in the upper right hand corner of the first page.

1HIPAA means the Health Insurance Portability and Accountability Act of 1996 as amended.
2The Privacy Rule refers to the privacy regulations issued by the Department of Health and Human Services pursuant to HIPAA, codified at 45 C.F.R. Parts 160 and 164.
3Summary Health Information means information that summarizes the claims history, claims expenses, or type of claims experienced by individuals for whom a Plan Sponsor has provided health benefits under a group health plan; and from which certain information has been deleted, including, but not limited to, names, Social Security numbers, street addresses, telephone numbers, account numbers, and medical record numbers.