This notice describes how medical information about you may be used or disclosed and how you can get access to this information. Please review it carefully.
Uses & Disclosures of Your Information
The AIA Insurance Program may use or disclose your health information for the purposes of routine treatment, payment or health care operations related to the Program. For example, the AIA Insurance Program may use and disclose your health information for management activities related to the Program, such as auditing, fraud and abuse detection, and customer service. The AIA Insurance Program may also use or disclose your health information through its third party administrator, Affinity Insurance Services, Inc., in order to pay your claims for benefits. For example, the AIA Insurance Program, though Affinity Insurance Services, may use your information to make eligibility determinations and for billing and claims management purposes. In addition, the AIA Insurance Program may disclose your health information to the AIA Trust so that the AIA Trust can perform administrative functions on behalf of the Program.
The AIA Insurance Program also may use or disclose your health information where required or permitted by law. Federal law, under the Health Insurance Portability and Accountability Act of 1996, generally permits health plans to use or disclose health information for the following purposes: where required by law; for public health activities; to report child or domestic abuse; for governmental oversight activities; pursuant to judicial or administrative proceedings; for certain law enforcement purposes; for a coroner, medical examiner, or funeral director to obtain information about a deceased individual; for organ, eye, or tissue donation purposes; for certain government-approved research activities; to avert a serious threat to an individual’s or the public’s health or safety; for certain government functions, such as related to military service or national security; or to comply with Workers’ Compensation laws.
For any other uses and disclosures of your health information, the AIA Insurance Program will obtain your written authorization. You may revoke this authorization in writing at any time, provided that the AIA Insurance Program has not yet taken action in reliance on your authorization. For an authorization form, click here; you may print this form, complete and sign it and send it to the AIA Insurance Program directly at 1735 New York Avenue, NW, Washington DC, 20006.
Your Rights With Respect To Your Health Information
You have several rights with respect to your health information, which are described below.
- You have the right to request restrictions on how your information may be used or disclosed. The AIA Insurance Program is not required to agree to your requested restriction.
- You have the right to receive health plan information confidentially, such as at a location other than your home, if you state in writing that disclosing the information through normal means could endanger you.
- You have the right to inspect and copy your health information that is maintained by the AIA Insurance Program in a designated record set. The AIA Insurance Program may charge a reasonable, cost-based fee for such copies.
- You have the right to request an amendment to your health information that the AIA Insurance Program maintains in a designated record set. The AIA Insurance Program may deny your request for an amendment if it believes your information is accurate and complete, or if the information was created by a party other than the AIA Insurance Program.
- You have a right to request an accounting of disclosures that the AIA Insurance Program has made of your health information for the six years prior to your request, except for disclosures you have authorized or disclosures for routine treatment, payment or health care operations of the AIA Insurance Program.
- You have a right to request a paper copy of this notice, even if you have agreed to receive this notice electronically.
Our Duties With Respect to Your Individually Identifiable Health Information
The AIA Insurance Program is required by law to maintain the privacy of your protected health information and to provide you with a notice of its legal duties and privacy practices with respect to your protected health information. The AIA Insurance Program is required to abide by the terms of this notice. The AIA Insurance Program reserves the right to change the terms of its notice and to make the new notice provisions effective for all protected health information that it maintains. If there is a material change to any provisions of this notice, the AIA Insurance Program will distribute a revised privacy notice.
If you have questions or would like more information about the AIA Insurance Program’s privacy policies, you may contact Ann Casso, Executive Director of the AIA Trust, (202) 626-7376 or by e-mail at email@example.com.
If you believe your privacy rights have been violated, you may file a complaint with the AIA Insurance Program or the Secretary of the U.S. Department of Health and Human Services. You cannot be retaliated against for filing such a complaint.
Effective Date of Notice: August, 2003