Privacy Information

The privacy pages linked below explain how we collect, treat, and protect your individually identifiable personal information ("personal information").

We will display a new date next to the Privacy Information link on the SIMPLICITYHEALTHPLANS.com home page whenever this page or any of the privacy statements or notices linked from it are updated or changed. We will also identify the specific privacy statement or notice that has changed by displaying the date of change next to the link to that notice.

Specifically, the Public Online Privacy Statement describes how we handle your personal information when you visit our public* websites.

The notices explain how we handle the personal information that you submit to us when you either: 1) visit our secure* websites that are only accessible to individuals who have relationships with us through our businesses (for example, you are covered by an Employer Sponsored health plan), or 2) contact us offline (for example, via phone) because you have a business relationship with us. The notices also explain rights you have regarding that information. We provide the notices to make you aware of these practices and to comply with the law, including the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

SIMPLICITYHEALTHPLANS Websites
Public Online Privacy Statement (09/16/2006)

SIMPLICITYHEALTHPLANS HealthCare
Notices of Privacy Practices (10/15/2007)
Reminder Regarding Access to Notice of Privacy Practices (09/21/07)
Gramm-Leach-Bliley Privacy Notice (09/21/07)
Privacy Forms (for requests)

Public Online Privacy Statement

SIMPLICITYHEALTHPLANS Websites: September 16, 2006

Why is this Public Online Privacy Statement important to me?

• SIMPLICITYHEALTHPLANS Public Online Privacy Statement
• Attention: Tomas Brian
• 20600 Chagrin Blvd. Suite 450
• Shaker Heights, Ohio 44122
• Toll Free: 877-747-1113
• Fax: 216-283-7931

Do the sites that you link to have the same privacy practices?

What types of information do you collect online?

How secure is my personal information online?

What do you do with the information you collect about me on your public websites?

What if I don't want you to collect, use or distribute my information electronically?

What should I know about sending email?

Sometimes when I'm online, I encounter pop-up ads, unusual links or other behavior that I find annoying and distracting. What is SIMPLICITYHEALTHPLANS position on these pop-ups and links?

Is there more information I should read?

How does this privacy statement apply to me if I'm not a U.S. customer?

Standard Privacy Practices

This Notice is Effective October 15, 2007

• Treatment. We may disclose your confidential information to your doctors, hospitals and other health care providers for their provision, coordination or management of your health care and related services - for example, for coordinating your health care with us or for referring you to another provider for care.
• Payment. We may use and disclose your confidential information to obtain payment of medical bills for your coverage and to determine and fulfill our responsibility to help manage your health plan benefits - for example, to make coverage determinations, administer claims and coordinate benefits with other coverage you may have. We also may disclose your confidential information to another health plan or a health care provider for its payment activities - for example, for the other health plan to determine your eligibility or coverage, or for the health care provider to obtain payment for health care services provided to you.
• Health Care Operations. We may use and disclose your confidential information for our health care operations - for example, to provide customer service and conduct quality assessment and improvement activities. Other health operations may include providing appointment reminders or sending you information about treatment alternatives or other health-related benefits and services. We also may disclose your confidential information to another health plan or a provider who has a relationship with you, so that it can conduct quality assessment and improvement activities - for example, to perform case management, disease management or health coaching.
• Disclosure to Persons Involved in Your Care. We may disclose confidential information about you or your child to persons who are involved in your or your child's care or payment for that care. For example, we might disclose confidential information about you to your spouse or confidential information about your child to your former spouse who is the parent of your child. We will disclose only the information that is relevant to the care or payment. Callers will be asked to provide identifying information and, if they are asking about a claim, they will have to show knowledge of that claim before we will answer their questions. You have the right to stop or limit this kind of disclosure by requesting a restriction on the disclosure of your confidential information as described below under "Right to Request Additional Restrictions."
• Disclosures to your Employer as Sponsor of Your Health Plan. We may disclose your confidential information to your employer or to a company acting on your employer's behalf, so that it can monitor, audit and otherwise administer the employee health benefit plan in which you participate. Your employer is not permitted to use the confidential information we disclose for any purpose other than administration of your health benefit plan. See your employer's health benefit plan documents for information on whether your employer receives confidential information and the identity of the employees who are authorized to receive your confidential information.
• Disclosures to SimplicityHealthPlans Vendors and Accreditation Organizations. We may disclose your confidential information to companies with whom we contract if they need it to perform the services we've requested — for example, vendors who help us provide important information and guidance to members with chronic conditions like diabetes and asthma. SimplicityHealthPlans also discloses confidential information to accreditation organizations such as the National Committee for Quality Assurance (NCQA) when the NCQA auditors collect Health Plan Employer Data and Information Set (HEDIS®)** data for quality measurement purposes. When we enter into these types of arrangements, we obtain a written agreement to protect your confidential information.
• Promotional Gifts. We may use your confidential information or disclose it to a mailing vendor so that we may provide you with a promotional gift of nominal value such as a pen or a calendar. We will not disclose your confidential information to other companies for their marketing purposes.
• Public Health Activities. We may disclose your confidential information for the following public health activities and purposes: (1) to report health information to public health authorities that are authorized by law to receive such information for the purpose of preventing or controlling disease, injury or disability; (2) to report child abuse or neglect to a government authority that is authorized by law to receive such reports; (3) to report information about a product or activity that is regulated by the U.S. Food and Drug Administration (FDA) to a person responsible for the quality, safety or effectiveness of the product or activity; and (4) to alert a person who may have been exposed to a communicable disease, if we are authorized by law to give this notice.
• Health Oversight Activities. We may disclose your confidential information to a government agency that is legally responsible for oversight of the health care system or for ensuring compliance with the rules of government benefit programs, such as Medicare or Medicaid, or other regulatory programs that need health information to determine compliance.
• For Research. Under very limited circumstances, your confidential information may be used and disclosed for research without an authorization - for example, an authorization would not be necessary if your name, street address and other identifying information were removed.
• To Comply with the Law. We may use and disclose your confidential information to comply with the law.
• Judicial and Administrative Proceedings. We may disclose your confidential information in a judicial or administrative proceeding or in response to a legal order.
• Law Enforcement Officials. We may disclose your confidential information to the police or other law enforcement officials, as required by law or in compliance with a court order or other processes authorized by law.
• Health or Safety. We may disclose your confidential information to prevent or lessen a serious and imminent threat to your health or safety or the health and safety of the general public.
• Government Functions. We may disclose your confidential information to the U.S. military or to authorized federal officials for purposes specified by federal law.
• Workers' Compensation. We may disclose your confidential information when necessary to comply with workers' compensation laws.

• Right to Request Additional Restrictions. You may request restrictions on our use and disclosure of your confidential information for the treatment, payment and health care operations purposes explained in this Notice. While we will consider all requests for restrictions carefully, we are not required to agree to a requested restriction.
• Right to Receive Confidential Communications. You may ask to receive communications of your confidential information from us by alternative means of communication or at alternative locations. While we will consider reasonable requests carefully, we are not required to agree to all requests.
• Right to Inspect and Copy your Confidential Information. You may ask to inspect or to obtain a copy of your confidential information that is included in certain records we maintain. Under limited circumstances, we may deny you access to all or a portion of your records. If you request copies, we may charge you copying and mailing costs.
• Right to Amend your Records. You have the right to ask us to amend your confidential information that is contained in certain records we maintain. If we determine that the record is inaccurate, and the law permits us to amend it, we will correct it. If your doctor or another person created the information that you want to change, you should ask that person to amend the information.
• Right to Receive an Accounting of Disclosures. Upon request, you may obtain an accounting of disclosures we have made of your confidential information. The accounting that we provide will not include disclosures made before April 14, 2003, disclosures made for treatment, payment or health care operations, and disclosures made earlier than six years before the date of your request, and certain other disclosures that are excepted by law. If you request an accounting more than once during any 12-month period, we will charge you a reasonable fee for each accounting statement after the first one.
• Right to Receive Paper Copy of this Notice. You may call Member Services at the toll-free number on your SimplicityHealthPlans ID card to obtain a paper copy of this Notice, even if you previously agreed to receive this Notice electronically.

• For More Information or Complaints. If you want more information about your privacy rights, do not understand your privacy rights, are concerned that we have violated your privacy rights or disagree with a decision that we made about access to your confidential information, you may contact our Privacy Office. You may also file written complaints with the Secretary of the U.S. Department of Health and Human Services. Please call our Privacy Office to obtain the correct address for the Secretary. We will not take any action against you if you file a complaint with the Secretary or us.

Reminder Regarding Access to Notice of Privacy Practices

Gramm-Leach-Bliley Privacy Notice
for Employer Sponsored plan members

• We’ve established a SimplicityHealthPlans privacy program office, which is responsible for monitoring our compliance with confidentiality policies and for educating SimplicityHealthPlans employees on this important topic.
• Whenever possible, we provide only aggregate information that doesn’t identify any individual.
• If we need to share your employees’ personal information, we have policies and procedures that protect confidentiality.
• Our employees may not disclose personal information to other employees except when it is needed to conduct SimplicityHealthPlans operations.
• In accordance with the HIPAA Privacy Rule, we require business associates who receive personal information and act on our behalf or provide a service to us to sign an agreement in which they promise that they will use information only for the purposes for which it was provided.
• In some situations, we require a member’s written authorization before we disclose personal information. For example, we will not supply personal information to a potential employer with whom a member is seeking employment without the member’s signed authorization, and we will not supply personal information to another company for its marketing purposes.
• We restrict access to personal information about our members to employees, service providers, and companies that are involved in administering health care coverage and servicing our members. We maintain physical, electronic and procedural safeguards that comply with federal standards to guard the personal information of our members.

• Medical providers and plan sponsors
• Insurers that provide reinsurance or excess (stop loss) insurance to an employer or with whom we are coordinating benefits.
• QuickPayNet, Ltd, DBA SimplicityHealthPlans affiliated companies and business associates like Advocare, Inc, Anthem Partners Rx, Whole Health Management, Inc., Employee Benefit Management Corp, and other business associates required to manage the members health benefits, such as dental and vision plans.
• Regulatory agencies such as departments of insurance and accreditation organizations such as the National Committee for Quality Assurance.
• Courts or attorneys who serve us with a subpoena.
• Successor companies or claim administrators who assume responsibility for administering your benefit plan.
• Companies that assist SimplicityHealthPlans in recovering overpayments, paying claims or performing utilization review services.
• Other companies not affiliated with SimplicityHealthPlans that provide services to us when disclosure is permitted or required by law.

Privacy Forms

• Request for Access to Health Care Information (PDF)
  
• Request to Amend Private Health Information (PDF)
  
• Request for Accounting (PDF)
  
• Request for Restriction of Use and Disclosure of Private Health Information (PDF)
  
• Request for Confidential Communications (PDF)
  
• Personal Representative Request (PDF)
  
• Statement of Disagreement/Request to forward Denial of Amendment Request (PDF)
  
• Change/Revoke Request (PDF)
  
• Authorization for Disclosure of Private Health Information (PDF)