US Family Health Plan

Johns Hopkins Notice of Privacy (NPP) Practices for Health Plans

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully. A copy of the Johns Hopkins US Family Health Plan’s NPP may be obtained by calling Customer Service at 1-800-808-7347.
Effective Date: May 1, 2013

Our pledge regarding your health information

The health plans covered by this Notice are committed to protecting health information about you. This Notice tells you about the ways in which we may use and disclose health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of your health information.

We are required by law to:

make sure that your health information is protected;
give you this Notice describing our legal duties and privacy practices with respect to your health information; and
follow the terms of the Notice that is currently in effect.

Definition of terms

When we say “Plan,” “we,” “our” or “us,” we refer to your particular health plan. When we say “you” in this Notice, we refer to the member of the Plan. The plans covered by this Notice are listed inside the back cover of this Notice. When we say “health information,” we include information that identifies you and tells about your past, present or future physical or mental health or condition and the provision of health care to you. This also includes information about payment for health care services, such as your billing records.

Who will follow this Notice?

The privacy practices described in this Notice will be followed by all health care professionals, employees, and business associates of the plans listed inside the back cover of this Notice.

How we may use and disclose health information about you

The following sections describe different ways that we may use and disclose your health information. We will describe each category of uses or disclosures and give some examples. Some information, such as certain drug and alcohol information, HIV information and mental health information, is entitled to special restrictions. We abide by all applicable state and federal laws related to the protection of this information. Not every use or disclosure will be listed. All of the ways we are permitted to use and disclose information, however, will fall within one of the following categories.

Treatment. We may use or disclose health information about you for treatment purposes. For example, we may use or disclose your health information to coordinate or manage your health care with your doctors, nurses, technicians, students or other personnel involved in taking care of you.

Payment. We may use and disclose health information about you for purposes related to payment for health care services. For example, we may use your health information to settle claims, to reimburse health care providers for services provided to you or give it to another health plan to coordinate benefits.

Health care operations. We may use and disclose health information about you for Plan operations. For example, we may use or disclose your health information for quality assessment and improvement activities, case management and care coordination, to comply with law and regulation, accreditation purposes, patients’ claims, grievances or lawsuits, health care contracting relating to our operations, legal or auditing activities, business management and general administration, underwriting, obtaining re-insurance and other insurance activities and to operate the Plan.

Appointment reminders. We may contact you to remind you that you have an appointment with a provider.

Treatment alternatives. We may contact you to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-related benefits and services. We may contact you about benefits or services that we provide.

Fund-raising activities. We may contact you to provide information about Plan-sponsored activities, including fund-raising programs and events to support research, teaching or plan member care. In addition to using your contact information, such as your name, address, phone, and dates of service provided to you, we may now use the hospital or clinic department where you were seen, the name of the physician you saw, the outcome of your treatment, and your health insurance status for such fund-raising purposes. If we do contact you for fund-raising activities, the communication you receive will have instructions on how you may ask for us not to contact you again for such purposes, also known as an “opt-out.”

News-gathering activities. We may contact you or one of your family members to discuss whether or not you want to participate in a news story for Plan-related publications or external news media. For example, a reporter may be doing a story on care management programs. If you had participated in such a program, we might ask if you would be willing to talk to the reporter. Your written authorization is required if we want to use or disclose any of your health information for these kinds of purposes.

Individuals involved in your care or payment for your care. Unless you say no, we may release medical information to anyone involved in your health care, such as a friend, family member, personal representative or any individual you identify. We may also give information to someone who helps pay for your care.

Disaster-relief efforts. We may disclose health information about you to an organization assisting in a disaster-relief effort so that your family can be notified about your condition, status and location. If you do not want us to disclose your health information for this purpose, we will not make the disclosure unless we must to respond to the emergency.

Research and related activities. Plan-related organizations conduct research to improve the health of people throughout the world. All research projects must be approved through a special review process to protect patient safety, welfare and confidentiality. Your health information may be important to further research efforts and the development of new knowledge. We may use and disclose health information about our enrollees for research purposes under specific rules determined by the confidentiality provisions of federal and state law.
Researchers may contact you regarding your interest in participating in certain research studies after receiving your authorization or approval of the contact from a special review board. Enrollment in those studies can occur only after you have been informed about the study, had an opportunity to ask questions and indicated your willingness to participate by signing a consent form.
In some instances, federal law allows us to use your health information for research without your authorization, provided we get approval from a special review board. These studies will not affect your eligibility benefits, treatment or welfare, and your health information will continue to be protected. For example, a research study may involve a chart review to compare the outcomes of patients who received different types of treatment.
In addition, federal law allows us to create a “limited data set”—a limited amount of health information from which almost all identifying health information, such as your name, address, Social Security number and medical record number, has been removed—and share it with those who have signed a contract promising to use it only for research, health oversight and health care operations purposes and to protect its privacy.

As required by law. We will disclose health information about you when required to do so by federal or state law.

To avert a serious threat to health or safety. We may use and disclose health information about you when necessary to prevent or lessen a serious and imminent threat to your health and safety or the health and safety of the public or another person. Any disclosure would be to help stop or reduce the threat.

Organ, eye and tissue donation. We may release health information to organizations that handle organ, eye or tissue procurement or transplantation, or to an organ-, eye- or tissue-donation bank, as necessary to help with organ, eye or tissue procurement, transplantation or donation.

Military. If you are a member of the armed forces, we may release health information about you to military authorities as authorized or required by law. We also may release health information about foreign military personnel to the appropriate military authority as authorized or required by law.

Workers’ compensation. We may disclose information about you related to claims for workers’ compensation or similar programs as authorized or required by law. These programs provide benefits for work-related injuries or illness.

Public-health disclosures. We may disclose health information about you for public-health purposes. These purposes generally include the following:

preventing or controlling disease (such as cancer and tuberculosis), injury or disability;
reporting vital events such as births and deaths;
reporting child abuse or neglect;
reporting adverse events or surveillance related to food, medications or defects or problems with products;
notifying persons of recalls, repairs or replacements of products they may be using;
notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition;
reporting to the employer findings concerning a work-related illness or injury or workplace-related medical surveillance; and
notifying the appropriate government authority as authorized or required by law if we believe an enrollee has been the victim of abuse, neglect, or domestic violence.

Genetic Information. As of September 23, 2013, the Plan may not use or disclose any genetic information about you for underwriting purposes.

Health-oversight activities. We may disclose health information to governmental, licensing, auditing and accrediting agencies as authorized or required by law.

Legal proceedings, lawsuits and other legal actions. We may disclose health information to courts, attorneys and court employees when we get a court order, subpoena, discovery request, warrant, summons or other lawful instructions from those courts or public bodies and in the course of certain other lawful, judicial or administrative proceedings.

Law enforcement. If asked to do so by law enforcement, and as authorized or required by law, we may release health information for law enforcement. For example, we may disclose medical information about a suspected victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement, or about a death suspected to be the result of criminal conduct.

Coroners, medical examiners and funeral directors. In most circumstances, we may disclose health information to a coroner or medical examiner. We may also disclose health information to funeral directors as necessary to carry out their duties.

National-security and intelligence activities. As authorized or required by law, we may disclose health information about you to authorized federal officials for intelligence, counterintelligence and other national-security activities.

Protective services for the U.S. president and others. As authorized or required by law, we may disclose health information about you to authorized federal officials so they may conduct special investigations or provide protection to the U.S. president, other authorized persons or foreign heads of state.

Inmates. If you are an inmate of a correctional institution or under the custody of law enforcement officials, we may release health information about you to the correctional institution as authorized or required by law.

Plan government programs providing public benefits. We may disclose your health information relating to eligibility for or enrollment in the Plan to another agency administering a government program providing public benefits, as long as sharing the health information or maintaining the health information in a single or combined data system is required or otherwise authorized by law.

Plan sponsor. We may disclose certain health and payment information about you to the Plan sponsor to obtain premium bids for the Plan or to modify, amend or terminate the Plan. We may release other health information about you to the Plan sponsor for purposes of Plan administration, but only if certain provisions have been added to the Plan to protect the privacy of your health information, and the sponsor agrees to comply with the provisions.

Your rights regarding health information about you

Your health information is the property of the Plan. You have the following rights, however, regarding health information we maintain about you:

Right to be Notified in the Event of a Breach. You have the right to be notified if your health information has been “breached,” which means that your health information has been used or disclosed in a way that is inconsistent with law and results in it being compromised.

Right to inspect and copy. With certain exceptions (such as psychotherapy notes, information collected for certain legal proceedings, and health information restricted by law), you have the right to inspect and/or receive a copy of your health information that is maintained by us or for us in enrollment, payment, claims settlement and case or medical management record systems, or that is part of a set of records that is otherwise used by us to make a decision about you.

We require you to submit your request in writing. We may charge you a reasonable fee for copying your records. We may deny access, under certain circumstances, such as if we believe it may endanger you or someone else. You may request that we designate a licensed health care professional to review the denial.

Right to request an amendment . If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan in enrollment, payment, claims settlement and case or medical management record systems, or that is part of a set of records that is otherwise used by us to make a decision about you.
We require you to submit your request in writing and to explain why the amendment is needed. If we accept your request, we will tell you we agree and we will amend your records. We cannot change what is in the record. We add the supplemental information by an addendum (an addition to the record). With your assistance, we will notify others who have the incorrect or incomplete health information. If we deny your request, we will give you a written explanation of why we did not make the amendment and explain your rights.
We may deny your request if the health information:

was not created by the Plan (unless the person or entity that created the health information is no longer available to respond to your request);
is not part of the enrollment, payment, claims settlement and case or medical management record systems maintained by or for us, or part of a set of records that we otherwise use to make decisions about you;
is not part of the information which you would be permitted to inspect and copy; or
is determined by us to be accurate and complete.

Right to an accounting of disclosures. You have the right to receive a list of the disclosures we have made of your health information since April 14, 2003.
This list will not include disclosures made:

to carry out treatment, payment and health care operations;
to you or your personal representative;
incident to a permitted use or disclosure;
to parties you authorize to receive your health information;
to your family members, other relatives or friends who are involved in your care, or who otherwise need to be notified of your location, general condition or death;
for national security or intelligence purposes;
to correctional institutions or law enforcement officials; or
as part of a “limited data set” (see page 4)

We require you to submit your request in writing. You must state the time period for which you want to receive the accounting, which may not be longer than six years and may not begin any sooner than April 14, 2003. The first accounting you request in a 12-month period will be free. We may charge you for responding to any additional requests in that same period.

Right to request restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information to a family member about a surgery you had.
To request a restriction, you must submit a written request. We are not required to agree to your request. If we do agree, our agreement must be in writing, and we will comply with your request unless the information is needed to provide you emergency treatment or we are required by law to disclose it. We are allowed to end the restriction if we tell you. If we end the restriction, it will affect health information that was created or received only after we notify you.

Right to request confidential communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may ask that we contact you only at home or only by mail. If you want us to communicate with you in a special way, you will need to give us details about how to contact you, including a valid alternative address. You also will need to give us information as to how payment will be handled. We may ask you to explain how disclosure of all or part of your health information could put you in danger. We will honor reasonable requests. However, if we are unable to contact you using the requested ways or locations, we may contact you using any information we have.

Right to request a disclosure. You have the right to request that we disclose your health information for reasons not provided in this Notice. For example, you may want your lawyer to have a copy of your health records. These requests must be provided to us in writing.

Right to a paper copy of this Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. Copies of this Notice are available throughout Johns Hopkins HealthCare LLC and Johns Hopkins Community Physicians, or by contacting the Johns Hopkins Privacy Officer as explained at the end of this Notice. You also may obtain an electronic copy at the Johns Hopkins Web site, http://www.hopkinsmedicine.org/patientcare.html.

Future changes to Johns Hopkins’ privacy practices and this Notice

We reserve the right to change this Notice and the privacy practices of the plans covered by this Notice. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. Copies of the current Notice will be available throughout Johns Hopkins HealthCare LLC and Johns Hopkins Community Physicians, or by contacting the Johns Hopkins Privacy Officer as explained at the end of this Notice. The current Notice will also be posted to the Johns Hopkins Web site, http://www.hopkinsmedicine.org/patientcare.html. At any time you may request a copy of the Notice currently in effect.

Our right to check your identity

For your protection, we may check your identity whenever you have questions about your treatment or payment activities. We will check your identity whenever we get requests to look at, copy or amend your records or to obtain a list of disclosures of your health information.

Exercise of rights, questions or complaints

If you would like to obtain an appropriate request form to (i) inspect and/or receive a copy of your health information, (ii) request a restriction on the use or disclosure of your health information, (iii) request confidential communications, or (iv) request a disclosure of your health information, or for other questions, please contact

Plan Administration
c/o Johns Hopkins HealthCare LLC
Compliance Department
6704 Curtis Court
Glen Burnie, MD 21060
Phone: 410-424-4828

If you would like to (i) request an amendment to your health information, or (ii) request an accounting of disclosures of your health information, please contact the Johns Hopkins Privacy Officer as specified below.

If you believe that your privacy rights have not been followed as directed by federal regulations and state law, or as explained in this Notice, you may file a written complaint with us. Please send it to the Johns Hopkins Privacy Officer at the address provided below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

If you have any questions or would like further information about this Notice, please contact:

Johns Hopkins Privacy Officer
5801 Smith Avenue
McAuley Hall, Suite 310
Baltimore, MD 21209
Phone: 410-735-6509
Fax: 410-735-6521
E-mail: hipaa@jhmi.edu

Other uses of health information

We may not use or disclose your health information for those purposes not covered by the Notice of Privacy Practices without first obtaining your written authorization (permission). Most uses and disclosures of your health information for marketing purposes fall within this category and require your authorization (permission) before we may use your health information for these purposes. Additionally, with certain limited exceptions, as of September 23, 2013, we are not allowed to sell or receive anything of value in exchange for your health information without your written authorization (permission).

This Notice is effective May 1, 2013, and replaces earlier versions.

Plans that will follow this Notice include the following:

The Broadway Services EHP Medical Plan
The Howard County General Hospital EHP Medical Plan
The Johns Hopkins Bayview Medical Center Employee Benefit Plan
The Johns Hopkins Bayview Medical Center Represented Employee Benefit Plan
The Johns Hopkins Health System Corporation/The Johns Hopkins Hospital Employee Benefits Plan for Non-Represented Employees
The Johns Hopkins Hospital Employee Benefits Plan for Represented Employees
The Johns Hopkins University EHP Classic
The Johns Hopkins University School of Medicine, the Bloomberg School of Public Health and the Johns Hopkins University School of Nursing Student Health Program
Uniformed Services Family Health Plan at Johns Hopkins

Health Care Fraud – What You Should Know

It has been estimated that over 60 billion dollars a year is spent on health care fraud. The Department of Defense (DoD) estimates 20% of all health care costs are due to fraud. The US Family Health Plan (USFHP) wants to find and stop health care fraud. Fraud is any dishonest act that results in a benefit to the person doing the act or someone else that he or she is not entitled to. Some examples of health care fraud are:

Using someone else’s USFHP insurance card to get health care services.
Loaning your USFHP insurance card to another person so that they can receive health care services.
Selling prescription medicine or items provided to you under the USFHP.
Forging or changing prescription forms.
Receiving bills for equipment or services you never received.

The Compliance Department at Johns Hopkins USFHP investigates all charges of actual or suspected health care fraud.

How Can I Help?

You can help reduce health care fraud by following these simple rules:

Never loan your USFHP insurance card to anyone;
Report all suspicions of fraud; and
Report lost or stolen insurance cards to the USFHP Customer Service Department at 1-800-808-7347 or 410-424-4528.

Remember health care fraud affects everyone. If you believe someone is committing fraud against the US Family Health Plan please report the act to the Compliance Department. You can remain nameless, and all reports are kept confidential. USFHP is committed to following all applicable laws and regulations, in particular those that address health care fraud, waste and abuse and the improper billing of health care services.

What happens to me if I report a concern?

US Family Health Plan takes its responsibility to protect your ‘right to report’ seriously! No employee may, threaten, coerce, harass, retaliate, or discriminate against, any individual who reports a compliance concern. To support this effort, the Health Plan has enacted zero-tolerance policies and annually trains all personnel on their obligation to maintain the highest integrity when handling compliance related matters. Any individual who reports a compliance concern has the ‘right’ to remain nameless and US Family Health Plan commits to enforcing this ‘right!’

How can I report fraud?

Reporting is simple! To contact the Compliance Department:

Call: 410-424-4996
Write: USFHP Compliance Department, 6704 Curtis Ct., Glen Burnie, MD 21060
Email: Compliance@jhhc.com
Fax: 410-424-4996

Release of Information

As a member and as required by HIPAA, you have the right to authorize the release of your Personal Health Information (PHI). You can do so by filling out one of the appropriate authorization forms. For additional information on your privacy, the protection of your written, oral and electronic PHI,or to read the Johns Hopkins HIPAA Web site, visit http://www.hopkinsmedicine.org/Privacy/patients.html

Privacy and Confidentiality

It is the policy of Johns Hopkins US Family health plan (USFHP) to protect the privacy and security rights of all of its health plan members; to maintain the confidentiality of Health Plan information (oral, written, and electronic); and to comply with all applicable federal and state privacy and security laws and regulations, including those under the Health Insurance Portability and Accountability Act (HIPAA).

Information provided to the Plan is kept confidential and will only be used by the Health Plan for such purposes as but not limited to

Care Coordination
Claims processing
Coordination of benefits with other plans
Subrogation of claims, review of a disputed claim
Program integrity activities (examples: investigation of fraud, waste, abuse, or privacy theft)
Quality improvement activities
Other health care operations and/or payment purposes

To ensure responsible maintenance of your phi, The Plan has implemented internal policies and procedures to address how we further protect, secure and limit use and disclosure of your oral, written, and electronic health Plan information. USFHP verifies the identities of both the member and requestor prior to responding to a request for a member’s PHI. Examples of such contact include but are not limited to:

Questions about your care management or payment activities
Requests to look at, copy, obtain, or amend your plan records
Requests to obtain a list of plan disclosures of your health information

The Plan secures and limits access to hardcopy and electronic files. Electronic data is password protected. Internal controls are in place to ensure that only those workforce members with a “need to know” have access to information required to perform their specific job functions. All workforce members are required to only utilize and/or access the “minimum necessary” information to perform their assigned tasks.

<Home