Privacy Policy

General Privacy Policy

This section describes the Fund’s policies that protect you from the unnecessary disclosure of your health information and how you can have access to this information. Please review it carefully. The Fund is required to protect the confidentiality of your private health information (PHI). The Fund’s privacy rules, adopted April 14, 2003, are still in effect.


The Plan will use protected health information to the extent and in accordance with the uses and disclosures permitted by the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA). Specifically, the Plan will use and disclose protected health information for purposes related to health care treatment, payment for health care, and health care operations.


You may find a complete description of your rights under HIPAA in the Plan’s Privacy Notice, which describes the Plan’s privacy policies and procedures and outlines your rights under the privacy rules and regulations.


Your rights under HIPAA include the right to:

  1. See and copy your health information, and request and receive electronic copies if it is readily producible electronically;
  2. Receive an accounting of certain disclosures of your health information;
  3. Amend your health information under certain circumstances; and
  4. File a complaint with the Fund or with the Secretary of Health and Human Services if you believe your rights under HIPAA have been violated.


If you need a copy of the Privacy Notice, please contact the Plan’s Privacy Official at the Fund Office.


Use and Disclosure of Protected Health Information

The Health Fund exists for one purpose—to provide health and welfare benefits to participants in the Fund. In the course of providing benefits, the Fund receives and maintains information that constitutes “protected health information,” as defined in federal privacy rules.


In this section, “you” means any person whose health information is received by the Health Fund. These rules apply to you whether you are an Employee, Retiree, or Dependent. Privacy rights can be exercised either by you or your Personal Representative (defined below). For a minor child, the parent is the Personal Representative.


PROTECTED HEALTH

INFORMATION (PHI)

All individually identifiable

health information transmitted

or maintained by the Plan that

relates to your past, present,

or future health, treatment,

or payment for health care

services.


If you need a copy of the HIPAA

Privacy Notice, please contact the

Fund Office.


Circumstances Where the Fund Uses or Discloses Health

Information


  1. To Process and Pay Claims. The Fund may use or disclose your health information to process and pay benefit claims. Claim processing includes all aspects of the process including, for example:
  2. Determining benefit eligibility or Plan coverage;
  3. Reviewing health care services for Medical Appropriateness, reasonableness of charges, and duration of Hospital stays;
  4. Providing information regarding coverage or health care treatment to another health plan to coordinate payment of benefits;
  5. Processing claim appeals;
  6. Calling you (or in your absence, a member of your household) to obtain information needed to process a claim; and
  7. Answering claim and benefit questions from you, your family members, or other relatives or close friends, if such individuals are involved with your health care or the payment of your claim.


  1. To Collect Contributions for Coverage. The Fund may use or disclose your health information in the process of collecting any payments, such as COBRA continuation coverage or Dependent coverage self-payments.


  1. For Administrative Purposes. The Fund may use or disclose health information for its own operations. Some examples are:


  1. Quality assessment and improvement activities.
  2. Activities designed to improve health or reduce health care cost.
  3. Underwriting, premium rating, or related functions to create, renew, or replace Plan benefits.
  4. Review and auditing, including compliance reviews, medical reviews, legal, services, and compliance programs.
  5. Business planning and development, including cost management and planning related analyses.
  6. General administrative activities of the Fund, including customer service and resolution of internal grievances.


  1. To Provide You with Health-Related Information. The Fund may use and disclose your health information to tell you about or recommend possible treatment options or alternatives or to advise you of health-related benefits and services that may be of interest to you.
  2. When Legally Required. The Fund will disclose your health information when it is required to do so by any federal, state, or local law, including, for example:


  1. When the Fund receives an order, issued by a court or a state agency, to disclose your health information.
  2. When the Fund receives a subpoena or discovery request in a lawsuit or workers’ compensation case. In the case of a subpoena or discovery request that has not been issued under a court order, the party requesting the information should notify you of the request so that you will have an opportunity to obtain a court order protecting your health information.


  1. To Conduct Health Oversight Activities. The Fund may disclose your health information to a health oversight agency for authorized activities including audits, civil administrative or criminal investigations, inspections, licensing, or disciplinary action.


  1. For Law Enforcement Purposes. As permitted or required by state law, the Fund may disclose your health information to a law enforcement official for certain law enforcement purposes, including, but not limited to, reporting a crime in an Emergency or if the Fund has reason to believe that your death was the result of criminal conduct.


  1. For Specified Government Functions. In certain circumstances, federal regulations require the Fund to use or disclose your health information to facilitate specified government functions, for example those related to the military and veterans, national security and intelligence activities, protective services for the president and others, and correctional institutions and inmates.


  1. In the Event of a Serious Threat to Health or Safety. The Fund may, consistent with applicable law and ethical standards of conduct, disclose your health information if the Fund, in good faith, believes that disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.


Persons Who Will Use Your Health Information


Adequate separation between the Plan and the Plan Sponsor must be maintained.


Therefore, in accordance with HIPAA, only the following Employees or classes of Employees may be given access to PHI:


  1. The Plan Administrator
  2. Staff designated by the Plan Administrator


These individuals may only have access to and use and disclose PHI for Plan administration functions that the Plan Sponsor performs for the Plan. If these individuals do not comply with this Plan Document, the Plan Sponsor shall provide a mechanism for resolving noncompliance issues, including disciplinary sanctions.


Releasing Health Information with Your Authorization

The previous categories (Circumstances Where the Fund Uses or Discloses Health Information) describe when the Fund will use or disclose your health information without your authorization. Other than as stated above, the Fund will not disclose your health information, except with your written authorization. The following

rules apply to authorizations to release health information:


  1. Authorizations will be in writing, signed by you or your Personal Representative.
  2. You or your Personal Representative will receive a copy of the authorization form.
  3. Authorizations have an expiration date that is stated on the authorization form.


You or your Personal Representative can revoke the authorization at any time. The revocation must be in writing, delivered to the Fund Office.


Your Rights with Respect to Your Health Information

You have the following rights regarding your health information that the Fund maintains:


  1. Right to Request Restrictions. You may request restrictions on certain uses and disclosures of your health information. The Fund is not required to agree to your request but the Fund will ordinarily honor any request that the Fund communicate only with you (that is, refrain from disclosing your claim or benefit information to your relatives, friends, or members of your household). If you wish to make a request for restrictions, please contact the Fund’s Privacy Coordinator.


  1. Right to Receive Confidential Communications. You have the right to request that the Fund communicate with you in a certain way. The Fund is not required to honor such requests but the Fund will do so if it can be done without interfering with the Fund’s normal operations or if you believe that the disclosure of your health information could endanger you. If you wish to receive confidential communications, please make your request in writing to the Fund’s Privacy Coordinator. Here are some examples of requests for confidential communications:


  1. A request that the Fund communicate only with you (that is, refrain from disclosing your claim or benefit information to your relatives, friends, or members of your household). The Fund will routinely grant this request.


  1. A request that the Fund only communicate with you at a certain telephone number or send written communications to a P.O. Box instead of your home.


  1. Right to Inspect and Copy Your Health Information. You have the right to inspect and copy your health information. A request to inspect and copy records containing your health information must be made in writing to the Fund’s Privacy Coordinator. If you request a copy of your health information, the Fund will charge you $0.25 per page for copying, plus actual mailing costs.


  1. Right to Amend Your Health Information. If you believe that your health information records are inaccurate or incomplete, you may request that the Fund amend the records. That request may be made as long as the information is maintained by the Fund. A request for an amendment of records must be made in writing to the Fund’s Privacy Coordinator. The Fund may deny the request if it does not include a reason to support the amendment. The request also may be denied if your health information records were not created by the Fund, if the health information you are requesting to amend is not part of the Fund’s records, if the health information you wish to amend falls within an exception to the health information you are permitted to inspect and copy, or if the Fund determines the records containing your health information are accurate and complete.


  1. Right to an Accounting. You have the right to request a list of certain disclosures of your health information that the Fund is required to keep a record of under federal privacy rules, such as disclosures for public purposes, disclosures authorized by law, or disclosures that are not in accordance with the Fund’s privacy policies or applicable law. The request must be made in writing to the Fund’s Privacy Coordinator. The request should specify the period for which you are requesting the information, but may not start earlier than April 14, 2003. Accounting requests may not be made for periods in excess of six years. The Fund will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests will be subject to a reasonable cost-based fee. The Fund will inform you in advance of the fee, if applicable.


  1. Right to a Copy of the Fund’s Privacy Notice. You have a right to request and receive a copy of the Fund’s Privacy Notice at any time, even if you have received the Notice previously. To obtain a copy, please contact the Fund’s Privacy Coordinator or any Employee at the Fund Office.


Your Personal Representative

If you are of legal age, you can exercise the HIPAA privacy rights explained in this section. Your rights can also be exercised by your Personal Representative. A Personal Representative is:


  1. The parent of a minor child.
  2. The person designated in a Health Care Power of Attorney (limited to the
  3. rights stated in the Power of Attorney).
  4. The legal guardian of a mentally incompetent adult.
  5. The administrator or executor of your estate or your next of kin.


Fund Obligations

The Fund is required by law to maintain the privacy of your health information, as described in this section, and to provide you the Privacy Notice of the Fund’s duties and privacy practices. The Fund is required to conform to the terms of these rules. The Fund reserves the right to change the terms of the Notice at any time. If that happens, the Fund will revise the Notice and will provide you with a copy of the revised Notice within 60 days of the change. Any change in the Fund’s privacy practices will apply to all health information that the Fund has, regardless of whether the information was obtained before or after the change in privacy practices. You have the right to submit any complaints regarding privacy issues to the Fund’s Privacy Coordinator. If you believe that your privacy rights have been violated, you have the right to report any violations to the Secretary of the Department of Health and Human Services. The Fund encourages you to express any concerns you may have regarding the privacy of your information. The Fund, your Employer, and your Union are not permitted to retaliate against you in any way for filing a complaint.


Contact Person

The Fund has a designated Privacy Coordinator. The Privacy Coordinator is the contact person for all issues regarding patient privacy and your privacy rights. You may contact the Privacy Coordinator at 10020 West Greenfield Avenue, Milwaukee, WI 53214, 1-800-255-3340 or 414-258-2336.


The Plan is required to protect the confidentiality and electronic security of your protected health information under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the rules issued by the U.S. Department of Health and Human Services.


You may find a complete description of your rights under HIPAA in the Plan’s Privacy Notice that describes the Plan’s privacy policies and procedures and outlines your rights under the privacy rules and regulations.


Your rights under HIPAA include the right to:


  1. Receive confidential communications of your protected health information, as applicable;
  2. See and copy your health information;
  3. Receive an accounting of certain disclosures of your health information;
  4. Amend your health information under certain circumstances; and
  5. File a complaint with the Plan or with the Secretary of Health and Human Services if you believe your rights under HIPAA have been violated.


If you need a copy of the Privacy Notice, please contact the Plan’s Privacy Official at the Fund Office.