FirstCare Privacy Policy

FirstCare/Southwest Life and Health Insurance Company
 
SHA, L.L.C.
 
NOTICE OF PRIVACY PRACTICES
 
Original Effective Date: April 14, 2003
 
Version 08152011
 
Para recibir este documento en español por favor llame al 1.800.829.6440.
 
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 many 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. In other payment activity, we send bills to your employer based on your specific eligibility information in order to receive premium payments from your employer in exchange for arranging health care benefits for you.
  • 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 examinersand funeral directors; to organ donation programs, 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 Actuarial, Scientific, Medical or Public Policy 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.
    • For Data Breach Notification Purposes. We may use your contact information to provide legally required notices of unauthorized acquisition, access, or disclosure of your health information. We may send notice directly to you or provide notice to the sponsor of your plan through which you receive coverage. 
Additional Restrictions on Use and Disclosure. Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including highly confidential information about you. “Highly confidential information” may include confidential information under Federal laws governing alcohol and drug abuse information and genetic information as well as state laws that often protect the following types of information: HIV/AIDS; Mental health; Genetic tests; Alcohol and drug abuse; Sexually transmitted diseases and reproductive health information; and Child or adult abuse or neglect, including sexual assault. If a use or disclosure of health information described above in this notice is prohibited or materially limited by other laws that apply to us, it is our intent to meet the requirements of the more stringent law.
 
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 situations listed above, FirstCare/SWLH will ask for your written authorization before using or disclosing information, and such authorization may not exceed 24 months from date of signing. You may cancel this authorization at any time in writing.  FirstCare/SWLH shall act on such cancellation as soon as possible (and in any case within 15 days of receipt), however, FirstCare/SWLH cannot take back any uses or disclosures already made with your authorization.
 
Your Privacy Rights
  • You Have the 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, 1901 West Loop 289, Suite 9, Lubbock, TX 79407. 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 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 at www.firstcare.com. 
  • 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 Review, Correct, or Limit Your Protected Health Information (PHI)
 
You may contact the FirstCare/SWLH Custodian of Records or the Privacy Officer at the address listed at the end of this notice 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 & Health Insurance Company
 
Custodian of Records
12940 N. Highway 183
Austin, TX 78750
Phone: 1.800.431.7737
Fax: 1.512.257.6016
Email: compliance@firstcare.com

Office for Civil Rights, Region VI
U.S. Dept. of Health & Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202
Phone: 214.767.4056
Fax: 214.767.0432
TDD: 214.767.8940
Email: www.hhs.gov/ocr

For More Information
 
If you have any questions about this notice or need more information, please contact the FirstCare/SWLH Privacy Officer.  Para recibir este documento en español  por favor llame al 1-800-829-6440.
 
FirstCare/Southwest Life & Health Insurance Company
Privacy Officer
12940 N. Highway 183
Austin, TX 78750
Phone: 1.800.431.7737
Fax: 1.512.257.6016
 
In the future, FirstCare/SWLH may change its Notice of Privacy Practices and make the changes effective on a going-forward basis. A copy of the new notice will be provided to each FirstCare/SWLH enrollee as required by law. The most current notice will always be posted on our internet web site.  You may ask for a copy of the current notice anytime by calling Customer Service at 1-800-829-6440 or get it online at www.firstcare.com.

FINANCIAL INFORMATION PRIVACY NOTICE
 
THIS NOTICE DESCRIBES HOW FINANCIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
 
FirstCare/SWLH is committed to maintaining the confidentiality of your personal financial information. For the purposes of this notice, "personal financial information" means information, other than health information, about an enrollee or an applicant for health care coverage that identifies the individual, is not generally publicly available and is collected from the individual or is obtained in connection with providing health care coverage to the individual.
 
Information FirstCare/SWLH Collects
 
We collect personal financial information about you from the following sources:
 
Information we receive from you on applications or other forms, such as name, address, age and Social Security number, information from a consumer report and information collected through an information collecting device from an internet web server; and information about your transactions with us, our affiliates or others, such as account balance information and premium payment history.
 
Disclosure of Information by FirstCare/SWLH
 
FirstCare/SWLH does not disclose personal financial information about you to any third party, except as required or permitted by law.  In the course of our general business practices, FirstCare/SWLH may disclose personal financial information about you or others without your permission other covered entities, or business associates for treatment, payment and certain health care operational purposes.  This may include your premium payment history.
 
Confidentiality and Security
 
FirstCare/SWLH restricts access to personal financial information about you to our employees and service providers who are involved in administering your health care coverage and providing services to you. We maintain physical, electronic and procedural safeguards in compliance with federal standards to guard your personal financial information. We conduct regular audits to guarantee appropriate and secure handling and processing of your information.
 
Your Right to Access and Correct Personal Information
 
You may have a right to request access to the personal financial information that we record about you. Your right includes the right to know the source of the information and the identity of the persons, institutions, or types of institutions to whom we have disclosed such information within two years prior to your request. Your right includes the right to view such information and copy it in person, or request that a copy of it be sent to you by mail. If requesting FirstCare/SWLH to copy and mail, we require you to include a $10.00 fee. Your right also includes the right to request corrections, amendments or deletions of any information in our possession. The procedures that you must follow to request access to or an amendment of your information are as follows:
 
To obtain access to your information: Submit a request in writing that includes your name, address, Social Security number, telephone number, and the recorded information to which you would like access. State in the request whether you would like access in person or a copy of the information sent to you by mail. Upon receipt of your request, we will contact you within 30 business days to arrange providing you with access in person or the copies that you have requested.
 
To correct, amend, or delete any of your information: Submit a request in writing that includes your name, address, Social Security number, telephone number, the specific information in dispute, and the identity of the document or record that contains the disputed information. Upon receipt of your request, we will contact you within 30 business days to notify you either that we have made the correction, amendment or deletion, or that we refuse to do so and the reasons for the refusal, which you will have an opportunity to challenge.

Send written requests to access, correct, amend or delete information to:
 
FirstCare/Southwest Life and Health Insurance Company
Custodian of Records
12940 N. Highway 183
Austin, TX 78750
Phone: 1.800.431.7737
Fax: 1.512.257.6016
Email: compliance@firstcare.com

To Report Privacy Practice Complaints:
HIPAA & Fraud Hotline: 1.800.718.5205
Fax Number: 512.257.6017
E-Mail: firstcaresiu@firstcare.com
U.S. Mail:
 
FirstCare Health Plans
Attn: Privacy Officer
12940 N. Highway 183
Austin, TX 78750

 

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