Privacy Notice

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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

EGID is a State of Oklahoma governmental agency that is created and governed by Oklahoma law for the purpose of administering health, life, disability, and dental benefits to state, local government, and education employees, and other groups designated by statute, including each of the preceding group’s respective retirees.

Oklahoma privacy laws and the federal Health Insurance Portability and Accountability Act (HIPAA) govern privacy matters between EGID and its participants concerning the privacy of an individual member’s health information. Information contained in an EGID member’s file is confidential by law and we at EGID are committed to protecting the privacy and security of members’ information. This notice describes and gives you examples of how EGID will use and disclose your health information and your rights regarding this information.

EGID uses and discloses your protected health information (PHI) for payment of services to enable your medical treatment, and for EGID business operations in the administration of health plans. The health claims you submit, or health claims submitted by providers for your treatment, contain protected health information and are processed for payment and data collection by claims administrators according to contract terms with EGID. EGID and its claim administrators use and disclose your PHI for payment responsibilities that include: collecting premiums, determination of medical necessity according to certification procedures, eligibility issues, coordinating benefits with other insurers, producing Explanations of Benefits, subrogation, and claim adjudication. Contract terms with each of its claims administrators state that the claims administrator is a Business Associate as defined in EGID Rules, with obligations to protect members’ information.

Your health information is used and disclosed by EGID employees and other entities under contract with EGID according to the “minimum necessary” standard. EGID or its claims administrators may use and disclose health information for HealthChoice plan operations that include: providing customer service, resolving grievances, conducting activities to improve members’ health and reduce costs, case management and coordination of care, premium rate setting activities, law enforcement, public health threats, workers’ compensation/disability, national security, and as permitted or required by law.

EGID provides limited member information to participating plan sponsors for enrollment purposes and premium comparison.

EGID will ask for your written permission before it uses or discloses your health information for purposes that are not described in this Notice.

You have the right to:

1. inspect and copy your health information (generally EOBs), with the exception of psychotherapy notes and/or information that requires a court order;
2. amend and restrict the health information that EGID discloses about you; however, EGID is not required to agree to a requested restriction;
3. request your communications remain confidential with EGID;
4. receive a copy of this Notice;
5. file a complaint if you believe EGID improperly used or disclosed your information;
6. request a listing of your protected health information disclosed by EGID except that, as a health plan, EGID is not required to account for disclosures for claims payment, EGID business operations, and disclosures you requested pursuant to your written Authorization; and,
7. receive a paper copy of this Notice upon request, if you received this Notice electronically.

EGID reserves the right to change the terms of this Privacy Notice and will provide all interested persons a revised notice either by U.S. Postal Service delivered to the individual’s mailing address on file with EGID, or through electronic communication by posting the revised Privacy Notice on the EGID website.

If you believe your privacy rights have been violated, call or send a written complaint to the EGID HIPAA Information Officer at 3545 NW 58th, Suite 110, Oklahoma City, Oklahoma, 73112, 1-405-717-8701, toll-free 1-800-543-6044, TDD 1-405-949-2281, toll-free TDD 1-866-447-0436; the Secretary of the U. S. Department of Health and Human Services (HHS) at the Office of Civil Rights, 1301 Young Street, Suite 1169, Dallas, TX 75202, 1-214-767-4056, or submit an electronic complaint according to directions located on the HHS Office of Civil Rights website.

Complaints to HHS must be filed within 180 days after the date on which you became aware, or should have been aware, of the violation. No retaliation is allowed against the individual filing a complaint.

Revised 2011

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