NOTICE OF PRIVACY PRACTICES of

SHA, LLC and Southwest Life & Health Company

FirstCare is a registered trademark of SHA, LLC.

Southwest Life & Health Company has been granted
usage rights to the FirstCare brand by SHA, LLC.

Original Effective Date: April 14, 2003

Version 07152005

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.

FirstCare / Southwest Life and Health Insurance Company (SWLH) provides HMO and health insurance coverage and services.We must collect information about you to provide these services. FirstCare / SWLH knows that information we collect about you and your health is private. We receive information about you from sources, including but not limited to, your employer, health care providers, other insurance companies and HMO's, our internet web portal, and other sources. FirstCare / SWLH is required to protect this information by Federal and State law. We call this information "protected health information" or "PHI".

This Notice of Privacy Practices will tell you how FirstCare / SWLH may use or disclose information about you. Not all situations will be described. FirstCare / SWLH is required to give you a notice of our privacy practices for the information we collect and keep about you. FirstCare / SWLH is required to follow the terms of the notice currently in effect. 

FirstCare / SWLH May Use and Disclose Protected Health Information Without Your Authorization in These Situations:

• For Treatment - FirstCare / SWLH may use or disclose information with health care providers who are involved in your health care. For example, information may be shared to create and carry out a plan for your treatment. 
• For Payment - Health Care Providers send bills ("claims") to us for payment of services rendered to you under your FirstCare / SWLH coverage.
• For Health Care Operations - FirstCare / SWLH may use or disclose information in order to manage its programs and activities. For example, FirstCare / SWLH may use PHI to review the quality of services you receive from healthcare providers.
• For the Following Other Reasons:
  • When Requested by A Public Health Authority by law or regulation (e.g., for compliance with communicable disease reporting requirements).
  • For Health Oversight Activities. Federal, State, and Local health oversight agencies, as authorized by law, may require information for audits, investigations, and inspections.
  • As Required by Federal, State, or local law.This may include disclosures to courts or administrative agencies involved in judicial or administrative proceedings; to government officials for matters of national security or for military or veterans activities; to correctional institutions if you are an inmate; to medical examiners and funeral directors; to to parents or guardians in compliance with state parental access laws; to government officials engaged in disaster relief; and, as required for compliance with workers' compensation programs.
  • For Abuse Reports and Investigations conducted by legitimate authorities (such as for investigations into possible child abuse or domestic violence).
  • For Government Benefit Programs. We may use and disclose information for public benefits as required under government-sponsored programs.
  • To Avoid Harm. FirstCare / SWLH may disclose PHI to law enforcement in order to avoid a serious threat to your safety or another person's, or the public's, safety.
  • For Research. FirstCare / SWLH uses information for studies and to develop reports as required on occasion by regulation or legislative mandate. These reports typically do not identify specific people, however.
  • Disclosures to Family, Friends, and Others. At critical times, or upon your request, FirstCare / SWLH may disclose information to your family or other persons who are involved in your medical care. You have the right to object to the sharing of this information.
  • For Identification and Location Purposes. FirstCare / SWLH may disclose information to assist law enforcement officials in identifying a suspect or a missing person.
  • For Criminal Investigations. FirstCare / SWLH may disclose information in response to law enforcement officials' requests in connection with criminal investigations.
  • For the Promotion of Health Maintenance and Wellness. FirstCare / SWLH may use information for purposes of notifying you of health benefits or services, or treatment alternatives that may be of interest to you.
  • To Plan Sponsors who have met the Privacy requirements for receiving PHI or de-identified information.

NOTE: We do not sell, rent, or license your PHI.Your PHI is not marketed to anyone by us.

Other Uses and Disclosures Require Your Written Authorization. For other situations that do not involve Treatment, Payment, or Healthcare Operations, or the other specific above, FirstCare / SWLH will ask for your written authorization before using or disclosing information. You may cancel this authorization at any time in writing. FirstCare / SWLH cannot take back any uses or disclosures already made with your authorization.

Your PHI Privacy Rights

Right to See and Get Copies of Your Records.

In most cases, you have the right to get copies of your records. You must make the request in writing by sending a letter to Custodian of Records, FirstCare / SWLH, 12940 North Highway 183, Austin, TX 78750. We require you to include a $10.00 fee for the cost of copying and mailing your records. The records will be a "designated record set", which means we have established a standard set of records for all requests of this nature. If your records are extensive, we may ask you to pay additional copying and postage costs before providing the information. Information about mental health claims or services will not be included:you will need to contact your mental health carrier or mental health providers for that information.

NOTE: FirstCare / SWLH is basically a payer of medical health care claims and its "records" consist mostly of claim information.We do not create or maintain "medical records" like those created and maintained by physicians, hospitals, and other medical providers. For those records, you will need to contact your providers. Also, you can obtain many of the same records instantly, and at no charge by using our secure FirstCare / SWLH Member Web Portals.

Right to Request to Correct or Update Your Records.

You may ask FirstCare / SWLH to change or add missing information to your records if you think there is a mistake. You must make the request in writing, and provide a reason for your request. It is unlikely that we have any records that would require enrollee corrections. We have the right to disagree with any proposed changes and are required to notify you of our action in either regard. Since we are a payer, and not a medical provider, it is unlikely that we would agree to any changes of medical records held by us.We will, or course, make changes to address, phone number, or similar items as appropriate when notified by your employer.

Right to Get a List of Disclosures.

You have the right to ask FirstCare / SWLH for a list of disclosures of your PHI made after April 14, 2003. You must make the request in writing. This list will not include the times that information was disclosed for routine health plan services which are "treatment, payment, or health care operations" as noted above. The list will not include information provided directly to you or your family, or information that was sent with any previous authorization made by you.

Right to Request Limits on Uses or Disclosures of PHI.

You have the right to ask that FirstCare / SWLH limit how your information is used or disclosed. You must make the request in writing and tell FirstCare / SWLH what information you want to limit and to whom you want the limits to apply. FirstCare / SWLH is not required to agree to the restriction. You can request (in writing or verbally) that the restrictions be terminated.

Right to Revoke Permission.

If you are asked, and agree to sign an authorization to allow FirstCare / SWLH to use or disclose information, you can cancel that authorization at any time. You must make the request in writing. This will not affect information that has already been shared pursuant to your authorization.

Right to Choose How We Communicate with you.

You have the right to ask that FirstCare / SWLH share information with you in a certain way or in a certain place. For example, you may ask FirstCare / SWLH to send information to your work address instead of your home address. You must make this request in writing. You do not have to explain the basis for your request.

Right to File a Complaint.

You have the right to file a complaint if you do not agree with how FirstCare / SWLH has used or disclosed information about you.

Right to Get a Paper Copy of this Notice.

You have the right to ask for a copy of this notice at any time.

NOTE : WE RESERVE THE RIGHT TO VALIDATE THE IDENTITY OF ANYONE MAKING ANY OF THE REQUESTS ABOVE, AS A FURTHER PROTECTION OF PHI.

How to contact FirstCare / SWLH to...

• Ask to look at or receive a copy your records
• Ask to correct or change your records
• Ask to limit how information about you is distributed
• Ask for a list of the times FirstCare / SWLH disclosed information about you outside of Treatment, Payment, or Operations
• Ask to cancel your authorization

FirstCare / SWLH may deny your request to look at, copy or change your records. If FirstCare / SWLH denies your request, FirstCare / SWLH will send you a letter that tells you why your request is being denied and how you can ask for a review of the denial. You will also receive information about how to file a complaint with FirstCare / SWLH or with the U.S. Department of Health and Human Services, Office for Civil Rights.

How to File a Complaint or Report a Problem

You may contact any of the people listed below if you want to file a complaint or to report a problem with how FirstCare / SWLH has used or disclosed information about you. Your benefits will not be affected by any complaints you make. FirstCare / SWLH cannot retaliate against you for filing a complaint, cooperating in an investigation, or refusing to agree to something that you believe to be unlawful 

FirstCare / Southwest Life and Health Insurance Company

Custodian of Records
12940 North Highway 183
Austin, TX 78750