Notice of Privacy Practices - HIPAA

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.

Effective Date of this Notice

​This notice has been updated and is effective November 8, 2017.

Why am I receiving this notice?

Partnership HealthPlan of California is required by law to provide you with adequate notice of the uses and disclosures of your protected health information that we may make, and of your rights and our legal duties and to notify you following a breach of your unsecured health information where your protected health information (PHI) is concerned. PHI is health information that contains identifiers, such as your name, Social Security number, or other information that reveals who you are.


We agree to follow the terms of this Notice of Privacy Practices. We also have the right to change the terms of this notice if it becomes necessary, and to make the new notice effective for all health information we maintain. If we need to make any changes, we will post it on our web site and notifying you via mail in our next annual mailing to you at your address in our records. If you received this notice electronically, you have the right to request a paper copy from us at any time.

How does Partnership HealthPlan of California (PHC) use and disclose my health information?
PHC stores health-related records about you, including your claims history, health plan enrollment information, case management records, and prior authorizations for treatment you receive. We use this information and disclose it to others for the following purposes:
  • Treatment. PHC uses your health information to coordinate your health care, and we disclose it to hospitals, clinics, physicians and other health care providers to enable them to provide health care services to you. For example, PHC maintains your health information in electronic form, and allows pharmacies to have on-line access to it to provide appropriate prescriptions for you.
  • Payment. PHC uses and discloses your health information to facilitate payment for health care services you receive, including determining your eligibility for benefits, and your provider's eligibility for payment. For example, we inform providers that you are a member of our plan, and tell them your eligible benefits.
  • Health care operations. PHC uses and discloses your health information as necessary to enable us to operate our health plan. For example, we use our members' claims information for conducting quality assessment and improvement activities, patient safety activities, business management and general administrative activities, and reviewing competence or qualifications of health care professionals.
For underwriting or related purposes, such as premium rating or other activities related to the creation, renewal or replacement of a contract of health insurance or benefits as required by law, but may not include genetic information.
  • Business Associates. PHC may contract with business associates to perform certain functions or activities on our behalf, such as facilitating a health-information exchange, where your health information can be quickly accessed by your doctors or to provide appointment reminders.
  • Health Information Exchange (HIE). PHC participates in multiple Health Information Exchange’s (HIE’s), which allow providers to coordinate care and provide faster access to our members. HIE’s assist providers and public health officials in making more informed decisions, avoiding duplicate care (such as tests), and reducing  the likelihood of medical errors. By participating in an HIE, PHC may share your health information with other providers and participants as permitted by law. If you do not want your medical information shared in the HIE, you must make this request directly to PHC. The ‘Individual Rights’ section below tells you how.

(Note: In some circumstances, your health information may not be disclosed. For example, mental health diagnosis and treatment, diagnosis or treatment for drug or alcohol abuse, and STD; birth control; or HIV test results are all considered ‘Protected Records’ and require your direct authorization to be shared.
 

When working to process payment, provide care to our members, or within our daily operations, PHC may disclose your health information to our contractors. Before we make any disclosures for payment or operational purposes, we obtain a confidentiality agreement from each contractor. For example, companies that provide or maintain our computer services may have access to health information within the course of providing services. PHC works to ensure that our providers have as minimal contact with your health information as possible.
 
Communication and Marketing: PHC will not use your health information for marketing purposes for which we receive payment without your prior written authorization. We may use your health information for case management or care coordination purposes and related functions without your authorization. We may provide appointment or prescription refill reminders or describe a product or service that is included in your benefit plan, such as our health provider network. We may also discuss health-related products or services available to you that add value, but are not part of your benefit plan. 

Sale of your health information: We will not sell your health information for financial payment without your prior written authorization.

Fundraising: We may use, or disclose to a business associate or to an institutionally related foundation, for the purpose of raising funds for the benefit of PHC, certain information without your authorization for fundraising purposes, including your name, address, contact information, age, gender, date of birth, dates of health care provided, treatment of service information, treating physician, outcome information and health insurance status. However, we will provide you with a clear and conspicuous opportunity to opt out of receiving further fundraising communications in a way that does not cause you undue burden or cost, and will honor that request. We will not condition treatment or payment on your choice with respect to the receipt of fundraising communications. We may provide you with a way to opt back in to receive such communications if you later prefer.
Can my health information ever be released without my permission?

Yes, we may disclose health information without your authorization to government agencies and private individuals and organizations in a variety of circumstances in which we are required or authorized by law to do so. Certain health information may be subject to restrictions by federal or state law that may limit or prevent some uses or disclosures. For example, there are special restrictions on the disclosure of health information relating to HIV/AIDS status, genetic information, mental health treatment, developmental disabilities, and drug and alcohol abuse treatment. We comply with these restrictions in our use of your health information.

Examples of the types of disclosures we may be required or allowed to make without your authorization include:

  • When Legally Required: PHC will disclose your health information when it is required to do so by any federal, state or local law
  • When there are Risks to Public Health: PHC may disclose your health information:
    • To public health authorities or to other authorized persons in connection with public health activities, such as for preventing or controlling disease, injury or disability or in the conduct of public health surveillance or investigations
    • To collect information or report adverse events related to the quality, safety or effectiveness of FDA regulated products or activities
    • To Report Abuse, Neglect, or Domestic Violence: PHC is mandated to notify government agencies if we believe a member is the victim of abuse, neglect or domestic violence.

In Connection with Judicial and Administrative Proceedings: PHC may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when PHC makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.

For Law Enforcement Purposes:

  • As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena, summons or similar process
  • For the purpose of identifying or locating a suspect, fugitive, material witness or missing person
  • Under certain limited circumstances, when you are the victim of a crime
  • To a law enforcement official if PHC has a suspicion that your death was the result of criminal conduct including criminal conduct at PHC
  • In an emergency in order to report a crime

To Coroners and Medical Examiners: PHC may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.

To Funeral Directors: PHC may disclose your health information to funeral directors consistent with applicable law and, if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, PHC may disclose your health information prior to, and in reasonable anticipation of, your death.

For Organ, Eye or Tissue Donation: PHC may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation, if you so desire.

In the Event of a Serious Threat to Health or Safety: PHC may, consistent with applicable law and ethical standards of conduct, disclose your health information if PHC, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

For Specified Government Functions: PHC may make disclosure to authorized federal officials in national security activities or for the provision of protective services to officials.

For Workers Compensation: PHC may release your health information for worker’s compensation or similar programs.

To a Correctional Institution or to a Law Enforcement Official: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the institution or official.

To other agencies administering government health benefit programs, as authorized or required by law.

For Immunization Purposes: To a school, about a member who is a student or prospective student of the school, but only if: (1) the information that is disclosed is limited to proof of immunization; (2) the school is required by the State or other law to have such proof of immunization prior to admitting the member; and (3) there is documented agreement by the member or the member’s guardian.

For Disaster Relief Purposes: PHC may make disclosure to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.

For Research Purposes: PHC may use or disclose protected health information for research purposes.

Can others involved in my care receive information about me?

Yes, we may release health information to a friend or family member who is involved in your care, or who is paying for your care, to the extent we judge it necessary for their participation unless you specifically ask us not to and we agree to that request. This includes responding to telephone enquiries about eligibility and claim status.

OTHER THAN WHAT IS STATED ABOVE, PHC WILL NOT DISCLOSE YOUR HEALTH INFORMATION OTHER THAN WITH YOUR WRITTEN AUTHORIZATION. IF YOU OR YOUR REPRESENTATIVE AUTHORIZES PHC TO USE OR DISCLOSE YOUR HEALTH INFORMATION, YOU MAY REVOKE THAT AUTHORIZATION IN WRITING AT ANY TIME.

Are there instances when my health information is not released?

We will not permit other uses and disclosures of your health information without your written permission, or authorization which you may revoke at any time in the manner described in our authorization form.

Except as described above (How does Partnership HealthPlan of California use and disclose my health information), disclosures of psychotherapy notes, marketing and the sale of your information require your written authorization and a statement that you may revoke the authorization at any time in writing.

YOUR INDIVIDUAL RIGHTS
What rights do I have as a PHC member?

As a PHC member you have the following rights with respect to your health information:

  • To ask us to restrict certain uses and disclosures of your health information. PHC is not required to agree to any restrictions requested by its members unless the disclosure is for the purpose of carrying out payment or health care operations and the request is solely for a health care item or service for which you, or another person other than PHC, has paid for the service(s) out of pocket.
  • You have the right to opt-out of a HIE if you do not wish to allow providers involved in your health care to electronically share your health information. In order to opt out, you must submit a Health Information Exchange Opt Out/ Opt In form. Upon receipt of your request, your health information will continue to be used and disclosed in accordance with this HIPAA Notice of Privacy Practices and the law, but will no longer be available to providers through our HIE(s).
  • You must give your consent for providers through our HIEs to view your Sensitive Health Information. Sensitive Health Information includes mental health diagnosis and treatment, diagnosis or treatment for drug or alcohol abuse, and STD; birth control; or HIV test results. PHC will disclose Sensitive Health Information when you authorize it by choosing to Opt In for Sensitive Health Information on the HIE Member Opt Out/ Opt In Form for Sensitive Protected Health Information. Opting in will permit this information to be seen by our providers through our HIE(s).
  • To receive confidential communications from PHC at a particular phone number, P.O. Box, or some other address that you specify to us.
  • To see and copy any of your health records that PHC maintains on you, including billing records, we must receive your request in writing. We will respond to your request within 30 days. We may charge a fee to cover the cost of copying, assembling and mailing your records, as applicable. You may also request PHC to transmit the information directly to another person if your written request is signed by you and clearly identifies both the designated person and where to send the information. In some situations, we may ask if you would agree to receive a summary or an explanation of the requested information and to any fees that might be imposed to create it. Under certain circumstances, PHC may deny your request. If your request is denied, we will tell you the reason why in writing. You have the right to appeal a denial.
  • If you feel the information in our records is wrong, you have the right to request us to amend the records. We may deny your request in certain circumstances. If your request is denied, you have the right to submit a statement for inclusion in the record.
  • You have the right to receive a list of our non-routine disclosures of your health information, up to six years prior from the date of your request. Non-routine disclosures do not include, for example, disclosures to carry out treatment, payment, health care operations, disclosures made with your authorization; disclosures made to you; and certain other disclosures. You are entitled to one disclosure list in any 12-month period at no charge. If you request any additional lists less than 12 months later, we may charge you a fee.
How do I exercise these rights?

You can exercise any of your rights by sending a written request to our Privacy Official at the address below. To facilitate processing of your request, we encourage you to use our request form, which you can obtain from our Internet website at www.partnershiphp.org or by calling us at the telephone number below. You can also obtain a complete statement of your rights, including our procedures for responding to requests to exercise your rights, by calling or writing to the Privacy Official at the address below.

Health Information Restriction Request Form

Release of Information Form |English|Russian|Spanish​|

How do I file a complaint if my privacy rights are violated?

As a PHC member, you or your personal representative have the right to file a complaint with our Privacy Official if you believe your privacy rights have been violated. You or your representative must provide us with specific written information to support your complaint; see contact information below. You may also file a complaint with the Secretary of Health and Human Services on their website or use the contact information listed below:

http://www.hhs.gov/ocr/privacy/hipaa/complaints/

PHC encourages you to contact us with any concerns you have regarding the privacy of your information. PHC will not retaliate against you in any way for filing a complaint. Filing a complaint will not adversely affect the quality health care services you receive as a PHC member. 

Contact Us:
Partnership HealthPlan of California
Attn: Privacy Officer
4665 Business Center Drive 
Fairfield, CA 94534

Telephone Number: (800) 863-4155 or TTY/TDD (800) 735-2929 or call 711

PHC's Complaint Hot-Line is (800) 601-2146 and is operated 24 hours a day, 7 days a week 
 
California Department of Health Care Services:
DHCS Privacy Officer 
1501 Capitol Avenue, MS 4721
PO BOX 997413 
Sacramento, CA 95899-7413
 
Phone: (916) 445-4646
Email: Privacyofficer@dhcs.ca.gov

TTY/TDD: (877) 735-2929

 

You can file a complaint with the United States Department of Health and Human Services at:

Centralized Case Management Operations  
U.S. Department of Health and Human Services 
200 Independence Avenue, S.W.​
Room 509F HHH Bldg.
Washington, D.C. 20201
 
Email to OCRComplaint@hhs.gov​ ​

Phone: (877) 696-6775
Or visit http://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html