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This Notice of Privacy Practices is effective April 14, 2003.
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 terms of this Notice of Privacy Practices apply to
Great American Financial Resources Health Insurance Companies
operating as affiliated covered entities1 with
Great American Life Insurance Company's Long Term Care Insurance Division,
Loyal American Life Insurance Company and
United Teacher Associates Insurance Company.
The terms of this Notice of Privacy Practices apply to, for example, the following types of insurance
policies: long term care insurance; Medicare supplement insurance; major medical insurance; cancer
insurance; heart attack and/or stroke insurance; hospital surgical policies; dental insurance; hospital or
intensive care unit insurance policies that pay benefits on an expense incurred basis; or any other
coverage that meets the definition of "health plan" as defined in the HIPAA Privacy Regulation. The
terms of this Notice of Privacy Practices do not apply to, for example, the following types of insurance
policies: life insurance; annuities; accident insurance; disability income insurance; hospital or intensive
care policies that pay benefits on an indemnity basis; or any other coverage that does not meet the
definition of "health plan" as defined in the HIPAA Privacy Regulation.
We understand that certain medical information about you and your health is protected. We are
committed to protecting health information about you, in accordance with pertinent laws and regulations.
This Notice will tell you about the ways in which we may use and disclose protected health information
about you. We also describe your rights and certain obligations we have regarding the use and
disclosure of your protected health information.
- make sure that health information that identifies you is kept private;
- give you this Notice of our legal duties and privacy practices with respect to protected health information about you; and
- follow the terms of the Notice that is currently in effect.
- We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make
the new Notice effective for all protected health information maintained by us. If material changes to our
Privacy Practices are made, copies of revised Notices will be mailed to all named insureds then covered under applicable health plans. As an insured under the covered policies, you have the right to obtain a paper copy of this Notice of
Privacy Practices, even if you have requested such copy by e-mail or other electronic means. Copies may be obtained by mailing a written request to our Privacy Officer at the address identified at the end of this Notice.
- Protected Health Information
Protected health information means information that is created or received by any one of the companies identified at the top of this Notice and relates to the past, present, or future physical or mental health or condition of a person who is covered by any one of the types of
insurance policies to which this Notice applies; the provision of health care to such covered person; or the
past, present, or future payment for the provision of health care to such covered person; and that identifies such covered person or for which there is a reasonable basis to believe that the information can be used to identify the covered person.
Your Authorization. Except as outlined below, we will not use or disclose your protected health
information for any purpose unless you have signed a form authorizing the use or disclosure. You have
the right to revoke that authorization in writing, except to the extent that we have taken action in reliance
upon the authorization or that the authorization was obtained as a condition of obtaining insurance and
we have the right, under other law, to contest a claim under the policy, or the policy itself.
We will make uses and disclosures of your protected health
information as necessary for payment purposes. For instance, we may use information regarding your
medical procedures and treatment to process claims and to determine coverage, to determine whether
services are medically necessary or to otherwise pre-authorize or certify services as covered under your
health benefits plan. We may also forward such information to another health plan that may also have an
obligation to process and pay claims on your behalf.
We will use and disclose your protected health
information as necessary for our health care operations which may include credentialing health care
providers, peer review, business management, accreditation and licensing, utilization review and
management, quality improvement and assurance, enrollment, underwriting, reinsurance, compliance, auditing, rating, and other functions related to your health benefits plan.
We will make disclosures of your protected health information as necessary
for your treatment. For instance, a doctor or health facility involved in your care may request certain
components of your protected health information that we hold in order to make decisions about your care.
Family and Friends Involved In Your Care. With your approval, we may from time to time disclose your
protected health information to family, friends, and others who are involved in your care or in payment for
your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you
are unavailable, incapacitated, or facing an emergency medical situation, and we determine that a limited
disclosure may be in your best interest, we may share limited protected health information with such
individuals without your approval. If you have designated a person to receive information regarding
payment of the premium on your policy, we will inform that person when your premium has not been paid.
We may also disclose limited protected health information to a public or private entity that is authorized to
assist in disaster relief efforts in order for that entity to locate a family member or other persons that may
be involved in some aspect of caring for you.
Certain aspects and components of our services may be performed through
contracts with outside persons or organizations, such as auditing, accreditation, actuarial services, legal
services, etc. At times it may be necessary for us to provide certain of your protected health information
to one or more of these outside persons or organizations who assist us with our health care operations.
We 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 an insured. 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 better is
available to you as an insured. 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.
- Other Uses and Disclosures
We are permitted or required by law to make certain other uses and disclosures of your protected health information without your authorization.
- We may use or disclose your protected health information for any purpose required by law.
- We may disclose your protected health information for public health activities, such as reporting of disease, injury, birth and death, and for public health investigations.
- We may disclose your protected health information if we suspect child abuse or neglect. We may also disclose your protected health information if we believe you to be a victim of abuse, neglect, or domestic violence.
- We may disclose your protected health information to a government oversight agency conducting audits, investigations, or civil or criminal proceedings.
- We may disclose your protected health information in the course of a judicial or administrative proceeding; for example to respond to a subpoena or discovery request.
- We may disclose your protected health information to the proper authorities for law enforcement purposes.
- We may disclose your protected health information to coroners, medical examiners and/or
funeral directors.
- We may use or disclose your protected health information for cadaveric organ, eye or tissue donations.
- We may use or disclose your protected health information to avert a serious threat to health or safety.
- We may disclose your protected health information for certain research purposes when such research is approved by an institutional review board with established rules to ensure privacy.
- We may use or disclose your protected health information if you are a member of the military as
required by armed forces services. We may also use or disclose your protected health information for other specialized government functions such as national security or intelligence activities.
- We may disclose your protected health information to workers' compensation agencies for your workers' compensation benefit determination.
- We may use or disclose your protected health information if it is included within a limited data set. However, we will not disclose your protected health information in a limited data set without first entering into a data use agreement with the recipient of the limited data set.
- We will, if required by law, disclose your protected health information to the Secretary of the
Department of Health and Human Services for enforcement of the Health Insurance Portability and Accountability Act (HIPAA).
In the event applicable law other than the HIPAA Privacy Regulation prohibits or materially limits our uses and disclosures of protected health information as set forth above, we will restrict our uses or disclosures of your protected health information in accordance with the more stringent standard.
Access to Your Protected Health Information. You have the right to copy and/or inspect much of the
protected health information that we retain on your behalf. All requests for access must be made in
writing, must state that you want to access your protected health information, and must be signed by you
or your representative. If you request a copy of your protected health information, we will charge a
reasonable fee based on our costs. You may obtain an access request form by contacting our Privacy
Officer at the address identified at the end of this Notice.
Amendments to Your Protected Health Information. You have the right to request in writing that
protected health information that we maintain about you be amended or corrected. We are not obligated
to make all requested amendments but will give each request careful consideration. All amendment
requests, in order to be considered by us, must be in writing, signed by you or your representative, and
must state the reasons for the amendment/correction requested. You may obtain an amendment request
form by contacting our Privacy Officer at the address identified at the end of this Notice.
You have the right to receive an
accounting of certain disclosures made by us of your protected health information. You may request an
accounting of the types of disclosures as described above under the title "Other Uses and Disclosures"
except for disclosures made for national security or intelligence purposes. Requests must be made in
writing and signed by you or your representative. You may obtain an accounting request form by
contacting our Privacy Officer at the address identified at the end of this Notice. The first accounting in
any 12-month period is free. We will charge a reasonable fee based on our costs for each subsequent
accounting you request within the same 12-month period.
You have the right to
request restrictions on certain of our uses and disclosures of your protected health information for
insurance payment or health care operations, disclosures made to persons involved in your care and
disclosures for disaster relief purposes. All requests for a restriction must be in writing and mailed to our
Privacy Officer at the address identified at the end of this Notice
Your request must describe in detail the
restriction you are requesting. We are not required to agree to your restriction request. We retain the
right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a
termination by us, we will notify you of such termination. You also have the right to terminate any agreed to
restriction by sending such termination Notice to our Privacy Officer at the address identified at the end
of this Notice.
You have the right to request that communications
regarding your protected health information be made by alternative means or at an alternative location.
We will accommodate reasonable requests if you inform us that disclosures of all, or part of, the
information could endanger you. Requests for confidential communications must be in writing, signed by
you or your representative, and mailed to our Privacy Officer at the address identified at the end of this
Notice.
If you believe your privacy rights have been violated, you can file a written complaint with
our Privacy Officer at the address identified at the end of this Notice. You may also file a complaint with
the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within
180 days of a violation of your rights. You will not be penalized for filing a complaint.
Massachusetts Residents Only. You may have additional privacy rights under Massachusetts law.
If you have questions or need further assistance regarding this Notice, you may contact:
Great American Financial Resources Health Insurance Companies
ATTN: Privacy Officer
P.O. Box 26580
Austin, Texas 78755-0580
1-800-880-8824
1 To the extent that any of the affiliated covered entities administers a covered policy on behalf of another insurance company, this Notice of Privacy Practices is also being provided on behalf of such other insurance company that originally issued the policy. |
