NOTICE OF PRIVACY PRACTICES
This Notice of Privacy Practices (“Notice”) describes how medical and personal health information about you may be used and disclosed by Nevada Dental Benefits, Ltd. (“NDB”) and its Business Associates. It will also advise you as to how you can get access to this information.
NDB is required by law to maintain the privacy of Protected Health Information, and to provide you with this Notice and inform you about your rights and our responsibilities concerning your Protected Health Information (“PHI”). PHI is individually identifiable health information that is maintained or transmitted by us in written, electronic or oral form. PHI includes information that can reasonably be used to identify you and relates to your health, the provision of healthcare or payment for services rendered. This may also include your name, Social Security Number and birth date.
NDB is required to abide by the terms of this Notice. NDB reserves the right to change the terms of this Notice and to make the new notice provisions effective for all PHI that it maintains. Any revised notice will be made available on the NDB website at www.nevadadentalbenefits.com.
Notice of PHI Uses and Disclosures
NDB may use and disclose your PHI without your authorization for purposes of treatment, payment for services rendered and healthcare operations, subject to the standards stated herein and the requirements of applicable law:
Payment: NDB may use and/or disclose your PHI for purposes of paying for treatment rendered or for billing and collecting for premium and/or fees due. This includes without limitation eligibility, coverage levels, coordination of benefits, utilization review, medical necessity review and adjudication of claims.
Treatment: NDB may use and/or disclose your PHI for purposes of treatment. This includes without limitation the provision, coordination and/or management of treatment among health care providers.
Health Care Operations: NDB may use and/or disclosed your PHI for purposes of health care operations. This includes without limitation the performance of quality assessment reviews, disease management programs, underwriting, rating, activities related to the management of your benefits, legal, consulting and auditing services, fraud and abuse programs, compliance programs, business planning and other related activities.
Business Associates of NDB may also use your PHI without your authorization for the same or similar services as listed above, but they must enter into an agreement with NDB to protect your PHI to the same extent as NDB.
Required Uses and Disclosures of PHI
At your written request, NDB must allow you to access your PHI for inspection and copying, with limited exceptions, and must allow you to obtain an accounting of certain disclosures of PHI as stated in this document elsewhere. NDB must also disclose your PHI if required by the Secretary of the Department of Health and Human Services (“HHS”) and its Office of Civil Rights or other authorized government organizations.
Other Permitted Uses and Disclosures
NDB may use or disclose your PHI without your authorization or opportunity to object under the following circumstances:
- Required by Law: NDB may use and/or disclose PHI when required by law.
- Law Enforcement: NDB may disclose your PHI to law enforcement officials for law enforcement purposes, including but not limited to, identifying or locating a suspect, fugitive, missing person, material witness or in response to a warrant.
- Public Health Activities: NDB may disclose your PHI to a public health agency for purposes of public health activities, including the prevention or control of disease.
- Public Health Oversight Agencies: NDB may disclose your PHI to government oversight agencies (e.g., HHS)
- Research: NDB may use and/or disclose your PHI for research, subject to certain conditions.
- Funeral Directors, Organ Donation, Medical Examiners, Coroners: NDB may disclose your PHI to a medical examiner, coroner and/or funeral director to allow them to carry out their duties. NDB may also disclose your PHI to organ procurement organizations to facilitate organ and/or tissue donation.
- Abuse or Neglect: NDB may disclose your PHI to public authorities when authorized by law to report information about abuse, neglect or domestic violence if there exists a reasonable belief that you are a victim.
- Judicial and Administrative Proceedings: NDB may disclose your PHI when required for judicial or administrative proceedings. Your PHI may be disclosed in response to a subpoena or discovery request subject to certain conditions.
- Military and National Security: NDB may disclose your PHI if you are a member of the Armed Forces, including veterans, for activities deemed necessary by authorized military command authorities. NDB may also disclose PHI to authorized federal officials for intelligence and national security activities authorized by law.
- Worker Compensation: NDB may disclose your PHI to comply with workers compensation or other similar programs established by law to provide benefits for work-related injuries or illness.
- Serious Threats to Health and Safety: NDB may disclose your PHI, with some limitations, to prevent or lessen a serious and/or imminent threat to your health or safety or the health or safety of another person or the public.
- Inmates: NDB may disclose your PHI to a correctional institution or a law enforcement official if you are in custody and it is necessary to provide you with healthcare, to provide for your health and safety or the safety of others.
Uses and Disclosures of PHI allowed after an Opportunity to Agree or Disagree
NDB may disclose your PHI to family members, other relatives or close personal friends if the information is directly relevant to the family’s or friend’s involvement with your health care or payment for such care and you have either agreed to the disclosure or have been given the opportunity to object and have not objected, or you are deceased and the disclosure is not inconsistent with any prior preferences known to NDB.
Prohibited Uses and Disclosures of PHI
NDB will not use or disclose PHI that is genetic information for underwriting purposes, including determining eligibility, for computing premiums or fees owed to NDB, or for other activities related to the enrollment or continued eligibility in your plan.
Uses and Disclosures of PHI that Require Your Written Authorization
NDB must obtain your written authorization for any use or disclosure of your PHI not specifically required or permitted by law or described in this Notice. NDB will not sell PHI or receive remuneration in exchange for the use or disclosure of PHI unless written authorization is obtained. NDB will not use or disclose PHI for marketing purposes unless written authorization is obtained. In the unlikely event that your PHI in the possession of NDB includes psychotherapy notes, those notes will not be used or disclosed by NDB without written authorization. NDB does not anticipate using or disclosing your PHI in a manner that would require your authorization, however, should authorization be required, NDB will provide you with an authorization form. You have the right to revoke your authorization at any time. If you do provide written authorization, it will allow PHI to be used and disclosed by both NDB and its authorized Business Associates.
Your Rights Regarding Your PHI
Request Restrictions on PHI
You have the right to request that NDB restrict uses or disclosures of your PHI. You also have the right to restrict uses and disclosures to family members, relatives, friends or other persons identified who are involved in your health care or payment for care. NDB, however, is not required to agree to your restriction request with one exception. NDB is required to comply with a restriction request if you request restricted disclosure of PHI to NDB for payment or health care operations purposes (not for treatment purposes) and the PHI at issue relates solely to a health care item or service for which you have paid the health care provider in full. You will be required to complete a form to request restrictions on uses of your PHI.
Confidential Communication of PHI
You have the right to request to receive confidential communications of PHI from NDB either by an alternative means or at alternative locations. You may request that NDB contact you at home, rather than at work, as an example. NDB may agree to accommodate any such request if it is reasonable. NDB must accommodate such requests if you clearly state that the disclosure of all or part of the PHI could endanger you. You will be required to complete a form requesting to receive confidential communication of PHI by alternative means or at alternative locations.
Access to PHI
You have the right to request access to your PHI in a designated record set for inspection and copying for as long as NDB maintains that PHI. A designated record set includes without limitation your medical billing records, enrollment, or claims payment records. You will be required to complete a request form to access your PHI in a designated record set. If you are granted access to inspect and copy your PHI, the requested information must be provided within thirty (30) days. A single thirty (30)day extension is allowed if NDB is unable to comply with the deadline.
Amendment of PHI
You have the right to make a written request to amend your PHI in a designated record set. Your written request must provide a reason in support of the requested amendment. You will be required to complete a form to amend your PHI. NDB has sixty (60) days after the request is made to act on the request. A single thirty (30)day extension is allowed if NDB is unable to comply with the deadline. NDB may deny your request if: a) the request for amendment is not in writing; b) the request for amendment does not provide any reason(s) for the requested amendment; c) the PHI or record that is the subject of the request was not created by NDB; d)the PHI or record that is the subject of the request is accurate or complete; or, e) the PHI or record would not be available to you for inspection or copying as discussed above. If the request is denied in whole or in part, NDB must provide you with a written denial that explains the basis for the denial. You may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of said PHI.
Accounting of PHI
You have the right to request an accounting of any disclosure of your PHI. NDB will only provide an accounting for the six (6) year period prior to the date of the request. NDB is not required to provide an accounting of disclosures: a) made by NDB to you; b)made to carry out treatment, payment or health care operations; c)incident to a use or disclosure otherwise permitted or required by law; d) pursuant to your authorization; e) to individuals involved in your care and for notification purposes permitted by law; f) for national security or intelligence purposes; g) to correctional institutions or law enforcement officials; or, h) as part of a limited data set.
You will be required to complete a written request to obtain an accounting of your PHI disclosures. NDB will provide you with an accounting, except as provided above, within sixty (60) days of your request. An additional thirty (30) days is allowed if NDB provides you with a written statement of the reasons for the delay. If you request more than one accounting within a twelve (12) month period, NDB will charge you a reasonable, cost-based fee for each subsequent accounting.
Receive a Paper Copy of This Notice Upon Request
You have the right to receive a paper copy of this Notice of Privacy Practices for PHI upon written request to NDB’s Privacy Officer, at the address listed herein.
Access by Personal Representative to PHI
NDB will treat your personal representative as you with respect to uses and disclosures of PHI, but only to the extent such PHI is relevant to their representation. Proof of such authority may take on any of the following forms:
- A power of attorney for health care purposes, notarized by a notary public.
- A court order of appointment as the conservator or guardian of you;
- An individual who is the parent, legal guardian or other person acting in loco parentis with legal authority to make health care decisions on behalf of a minor child; or
- An executor of the estate, next of kin or other family member on behalf of a decedent.
NDB retains the discretion to deny a personal representative access to PHI if NDB reasonably believes that you have been or may be subject to domestic violence, abuse, neglect or coercion, or that treating a person as your personal representative could endanger you.
File A Complaint
You have the right to file a complaint with NDB if you believe that your privacy rights have been violated. All complaints to NDB are to be filed with the NDB Privacy Officer at the address listed herein. You may also file a complaint with HHS in writing, electronically via the Office of Civil Rights (“OCR”) Complaint Portal or on paper by faxing, emailing or mailing it to the applicable OCR regional office. NDB may not retaliate against you for filing a complaint. For more information on filing a complaint with HHS, please visit www.hhs.gov/ocr/privacy/hipaa/complaints or call 800-369-1019 to request a complaint form.
All complaints must be in writing and filed within one hundred eighty (180) days of the date you knew or should have known of the violation.
Notification of Breach of Unsecured PHI
NDB is required by law to notify you following any breach of unsecured PHI. No later than sixty (60) days from the discovery of any breach, NDB will provide you with notice of such breach.
The contents of this notice do not apply to de-identified health information. NDB may use and disclose your de-identified health information without the restrictions set forth in this notice. Health information is considered de-identified if it does not identify you and there is no reasonable basis to believe that the information can be used to identify you.
Summary Health Information
NDB may disclose summary health information to a Business Associate. Summary health information is information that may be individually identifiable information that summarizes the claims history and claims experiences of participants in its programs.
If you wish to file a complaint or have any question regarding this notice you may contact: Privacy Officer, Nevada Dental Benefits, Ltd. 7872 W. Sahara, Las Vegas, NV 89117. 702-478-2014, fax 702-333-9140.