Notice of Privacy Practices

BOSTON TEACHERS UNION HEALTH & WELFARE FUND
AND
BOSTON TEACHERS UNION PARAPROFESSIONAL HEALTH & WELFARE FUND

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.

The Boston Teachers Union Health & Welfare Fund and the Boston Teachers Union Paraprofessional Health & Welfare Fund (“the Funds”) are committed to maintaining the confidentiality and privacy of your healthcare information. Further, as health plans which are “covered entities” subject to the federal Privacy Rule issued by the US Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA), the Funds are required to maintain the privacy of your individually-identifiable health information and to provide you with notice of our legal duties and privacy practices with respect to your health information which in this Notice is referred to as Protected Health Information (PHI).

The Funds provide certain supplemental health benefits to teachers and paraprofessionals employed by the Boston School Committee and members of their families. Covered benefits include:

  • Eye care
  • Dental care
  • Hearing aids
  • Supplemental mental health benefits (Boston Teachers Union Health & Welfare Fund participants only)
These functions make the Funds subject to the HIPAA Privacy Rule in their capacity as health plans. This Notice describes how we use and disclose your PHI in performing our health plan functions.

How the Funds May Use or Disclose Your Protected Health Information (PHI)

The Funds may use and disclose your PHI for treatment, payment and healthcare operations, for purposes required by state or other applicable federal law, and for other purposes permitted by the HIPAA Privacy Rule without your written authorization. The following categories describe the ways in which we may use and disclose your PHI. For each category of uses and disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, the various ways we are permitted to use and disclose information will generally fall within one of these categories.

  1. Treatment, Payment, and Health Care Operations
    (Note: State law requires that we ask for your authorization before disclosing any records relating to mental health or substance abuse treatment.)
    1. Treatment. As a health plan, our role is generally to arrange and/or pay for health services provided to you by health care providers, rather than to provide direct treatment ourselves, other than in the Eye Care Center. However, we may disclose your PHI to appropriate persons in order to coordinate your care or to conduct case management activities, and that is considered “treatment” under the Privacy Rule.
    2. Payment. We may use or disclose PHI about you to determine eligibility for plan benefits, facilitate payment for the treatment and services you receive from health care providers, determine plan responsibility for benefits, and coordinate benefits. For example, payment functions may include reviewing the medical necessity of certain health care services, or determining whether a service is covered under your plan.
    3. Health Care Operations. We may use and disclose PHI about you to carry out necessary administrative functions. For example, such activities may include: conducting quality assessment and improvement activities; underwriting and premium rating; conducting or arranging for dental review, legal services, audit services, accreditation activities, business planning, management and general administration.
  2. Required By Law.
  3. We may be required by state or federal law to report certain matters to government agencies (e.g. suspected child abuse), although most required reporting comes from health care providers rather than health plans.
  4. Permitted Uses and Disclosures
    1. Health Oversight Activities. We may disclose your PHI to health agencies during the course of audits, investigations, licensure, and other proceedings related to oversight of the health care system.
    2. Disclosures About Abuse, Neglect or Domestic Violence. We may disclose your PHI, consistent with applicable federal and state laws, if we believe that you have been a victim of abuse, neglect, or domestic violence. Such disclosure will be made to the governmental entity or agency authorized to receive such information.
    3. Judicial and Administrative Proceedings. We may disclose your PHI in the course of an administrative or judicial proceeding. For example, we may disclose medical or insurance information when required by a court order in a litigation proceeding.
    4. Law Enforcement. Under limited circumstances (such as required reporting laws or in response to a grand jury subpoena), we may disclose your PHI to law enforcement officials.
    5. Coroners, Medical Examiners, and Funeral Directors. We may disclose your PHI to a coroner, medical examiner, or funeral director as necessary for them to carry out their duties.
    6. Organ and Tissue Donation. If you are an organ donor, we may disclose your PHI to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
    7. Research. We may disclose your PHI to researchers when an institutional review board or a privacy board has (a) reviewed the research proposal and established protocols to ensure the privacy of the information; and (b) approved the research.
    8. Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety, or to the health and safety of others. Any such disclosure will be made to someone who would be able to help prevent the threat.
    9. National Security. We may disclose your PHI for national security purposes as authorized by federal law.
    10. Workers’ Compensation. We may disclose your PHI to the extent necessary to comply with laws concerning workers’ compensation or to comply with similar programs that are established by law and provide benefits for work-related injuries or illness.
    11. Disclosures to Plan Sponsors (Board of Trustees). We may disclose certain information to the sponsor of your group health plan (Board of Trustees), for purposes of administering benefits under the plan, provided that certain confidentiality requirements under the Privacy Rule have been met.
    We may contract with others to assist us with our treatment, payment, health care operations, or other activities that involve the use of your PHI. Such other parties may be our business associates. We require business associates to agree, in writing, to contract terms designed to safeguard your PHI that is shared with them.

Other Uses or Disclosures Require Your Written Authorization

Except as described above, we will not use or disclose your PHI without specific written authorization from you. If you do authorize us to use or disclose your PHI for another purpose, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose PHI about you for the reasons covered by your written authorization, though we will be unable to take back any disclosures we have already made with your permission.

Your PHI Rights

You have certain rights under the Privacy Rule. If you would like to exercise any of these rights, please submit your request in writing to the Funds’ Privacy Officer, c/o Boston Teachers Union Health & Welfare Funds, 180 Mount Vernon Street, Boston, Massachusetts 02125-3198 (Phone 617-228-0500).

  1. Right to Inspect and Copy. You have the right to request, in writing, to inspect and obtain a copy of PHI in the possession of the Funds that may be used to make decisions about you and your plan benefits. If you request a copy of the information, we may charge you a reasonable fee to cover expenses associated with your request. If your request is denied, we will provide you with information about our denial and how you can file a statement of disagreement.
  2. Right to Request Confidential Communications. You have the right to receive your PHI through a reasonable alternative means or at an alternative location, if you write us that receipt at your normal address might endanger you. Your request must be in writing. We will make every effort to comply with your request. If your request is denied, we will provide you with information about our denial and how you can file a statement of disagreement.
  3. Right to Request Amendment. You have a right to request that the Funds amend any PHI record that you believe is incorrect or incomplete. You must provide a reason for your request. We are not required to change your PHI unless we are responsible for creating the record and we agree it is incorrect or incomplete. If your request is denied, we will provide you with information about our denial and how you can file a statement of disagreement.
  4. Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your PHI. The Funds are not required to agree to the restrictions that you request.
  5. Right to Accounting of Disclosures. You have the right to receive a list or “accounting” of disclosures of your PHI made by us or our business associates, except that we do not have to account for disclosures made for purposes of treatment, payment, or health care operations, or disclosures authorized by you. Your request should specify a time period of up to six years and may not include dates before April 14, 2003. If your request is denied, we will provide you with information about our denial and how you can file a statement of disagreement.
  6. Right to Paper Copy. You have a right to receive a paper copy of our current Notice of Privacy Practices at any time. You may also obtain a copy of this Notice at our website, at www.btuhwf.org.

If you would like to have a more detailed explanation of these rights or if you would like more information on how to exercise one or more of these rights, contact the Funds’ Privacy Official at:

Boston Teachers Union Heath and Welfare Fund
Boston Teachers Union Paraprofessional Health and Welfare Fund
180 Mount Vernon Street
Boston, MA 02125-3198

Changes to This Notice of Privacy Practices

The Funds reserve the right to amend this Notice of Privacy Practices at any time in the future and to make the new notice provisions effective for all PHI that we maintain. We will promptly revise our notice and distribute it to you whenever we make material changes to the notice. Until such time, we are required by the Privacy Rule to comply with the current version of this notice.

Complaints

If you believe your privacy rights have been violated or if you have a complaint about how we handle your PHI, you should send a letter to Privacy Official, Boston Teachers Union Health & Welfare Funds, 180 Mount Vernon Street, Boston, Massachusetts 02125-3198. If you believe your privacy rights have been violated, you may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, Washington, DC 20201.

For More Information

If you have questions about any part of this Notice or want more information about the Funds’ privacy policies and procedures, call the Funds’ Privacy Official at (617) 288-0500.

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