Surency Life and Health Insurance Company
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have questions concerning this notice, please contact:
Surency Life & Health Insurance Company
P.O. Box 789773
Wichita, KS 67278-9773
(316) 219-5749 or (888) 316-5986
Surency Life & Health Insurance Company, Inc. (the “Plan”) is required by law to maintain the privacy of your health information and to provide you with this notice of our legal duties and privacy practices with respect to your health information and we are committed to protecting the privacy and confidentiality of your health and personal information.
HOW THE PLAN MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
Uses and Disclosures of Protected Health Information Without Your Specific Authorization
The Plan may use and disclose your health information about you for payment or health care operations without any consent or authorization beyond your enrollment in the Plan.
Payment means activities related to the Plan’s payment to pay you or your health care provider for covered expenses. Activities associated with payment include, but are not limited to, enrollment activities; collection of contributions from you and your employer; payment for covered expenses, including coordination of benefits; review of payment decisions upon appeal; activities related to pre-authorization of benefits and utilization review; and disclosure of contribution payment history to a consumer reporting agency.
Treatment. We may use and disclose your PHI to dentists, doctors, pharmacies, hospitals, and other health care providers who take care of you to facilitate the coordination of healthcare treatment and services you receive. For example, dentists may request medical information from us to supplement their own records.
Health Care Operations means activities undertaken to administer your program including, but not limited to, activities necessary to reduce overall health care costs; contacting you or your health care provider about alternative treatments; evaluating practitioner and provider performance; training of non-health care professionals; activities related to obtaining an insurance contract, such as census rating for premiums; conducting or arranging for claims review, legal services, and auditing functions; fraud and abuse detection and compliance-related activities; analysis related to managing and operating the Plan; development or change of payment methods or coverage policies; and educational activities.
Under applicable federal law, there are other uses and disclosures the Plan may make without your specific authorization some are included below:
Disclosures of Protected Health Information to the Plan Sponsor. The Plan will disclose protected information only to the minimal extent it helps your employer administer the program, such as providing billing information, and confirmation of enrollment. The employer must limit its use of that information to obtaining quotes or modifying, amending, or terminating the Plan.
Creation of de-identified health information. The Plan may use your protected health information to create de-identified health information. This means that all data items that would help identify you, such as name, address, birth date, and hire date are removed or modified. Once information is de-identified it is no longer protected.
Furnishing data to Business Associates. The Plan’s Business Associates (e.g., printers, mailing services, legal counsel, and consultants) receive and maintain your protected health information to carry out payment and health care operations.
Uses and disclosures required by law. The Plan will use and/or disclose your protected health information when required by law to do so. The disclosure will be the minimum necessary to fulfill the legal requirement.
Disclosures for public health activities. We may disclose your protected health information for the following public health activities in circumstances that would help prevent or control disease, report child abuse, and domestic violence. Such disclosure will be made only to extent required by law or with your agreement.
Disclosures for health oversight activities. The Plan may disclose your protected health information to a health oversight agency for oversight activities to complete applicable audits, investigations or inspections.
Disclosures for judicial and administrative proceedings. Your protected health information may be disclosed during any judicial or administrative proceeding as required by appropriate administrative or judicial court proceedings.
Disclosures for law enforcement purposes. We may disclose your protected health information to a law enforcement official as required by law or to comply with a court order, court-ordered warrant, a subpoena, or summons issued by a judicial officer.
Disclosures regarding victims of a crime or to avert a serious threat to health or safety. In response to a law enforcement official’s request, the Plan may disclose information about you with your approval or in an emergency situation and you are incapacitated, or if it appears you were the victim of a crime. We may also disclose your protected health information to prevent or lessen a serious and imminent threat to the health and safety of a person or the public or as necessary for law enforcement authorities to identify or apprehend an individual.
Disclosures for specialized government functions. The Plan may disclose your protected health information as required to comply with governmental requirements for national security reasons or for protection of certain government personnel or foreign dignitaries.
Fundraising. We may send you information as part of our fundraising activities. You have the right to opt out of receiving this type of communication.
Underwriting. We may use or disclose your PHI for underwriting purposes. However, we will not use or disclose any PHI consisting of genetic information for any underwriting purposes.
Other Uses and Disclosures. Other permitted disclosures include, where appropriate and under circumstances permitted by law, the provision of PHI to report child abuse or neglect to a government authority authorized by law to receive such reports; to a coroner, medical examiner, and/or funeral director as necessary to carry out their duties as authorized by law; to organ procurement organizations to facilitate donations and transplantations; for research purposes, such as research related to the evaluation of certain treatments or the prevention of disease; and to a correctional institution if disclosure is necessary to provide an inmate with health care or to protect the health and safety of an inmate or others.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right To Inspect and Copy. You have the right to inspect and copy health information collected and maintained by the Plan. To inspect and copy your health information, you must complete a specific form providing information needed to process your request from the Privacy Officer at the address identified on this Notice. You may request that your health information be provided in an electronic form and we can work together to agree on an appropriate electronic format. You may be charged a fee to cover expenses associated with your request. We can refuse access under certain circumstances. If the Plan refuses access, you will be notified in writing and may be entitled to have a neutral person review the refusal.
Right To Amend Incorrect or Incomplete Information. You may request that Plan change your health information, although we are not required to do so. If your request is denied, we will provide you with information about our denial and how you can disagree with the denial. To request an amendment, you must make your request in writing. You must also provide a reason for your request.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of health information about you, with certain exceptions specifically defined by law. To request this list or accounting of disclosures, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the Privacy Officer at the address identified on the first page of this Notice.
Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
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 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, like a family member or friend. To request restrictions, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the Privacy Officer at the address identified on the first page of this Notice.
We are not required to agree to your request for restrictions. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
Right to Request Alternative Methods of Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request an alternative method of communications, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the Privacy Officer at the address identified on the first page of this Notice. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
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. To obtain a paper copy of this notice, contact the person identified on the first page of this Notice. You may obtain a copy of this notice at our website, www.surency.com
Right to Breach Notification. You have the right to be notified if we determine that there has been a breach of your protected health information.
If you believe we may have violated your privacy rights, you may follow the steps below to file a complaint:
- Submit a written complaint to our Privacy Officer at the address listed above.
- Submit a written complaint with the Secretary of the U.S. Department of Health and Human Services Office for Civil Rights by using one of the following methods:
- Email - OCRComplaint@hhs.gov
- Online - https://ocrportal.hhs.gov/ocr/cp/complaint_frontpage.jsf
- Mail – Send complaints to:
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
You will not be penalized if you choose to file a complaint.
The effective date of this Notice is July 1, 2021. The Plan reserve the right to change the terms of this notice and to make the revised notice effective with respect to all protected health information regardless of when the information was created. If the notice is revised, the new notice will be provided to you, if you are still covered by the Plan, either through e-mail or U.S. postal service, within sixty days of such revision. Otherwise, we will provide you once every three years a reminder of the availability of this Notice and how to obtain the Notice.
Surency Life & Health is committed to the highest standard of business policy, procedure and conduct. This section provides information on privacy policies, information about Health Care Reform and how we are complying with the changes, and contact information for anonymous fraud and abuse reports.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides federal protection for individually identifiable health information held by covered entities and gives patients an array of rights with respect to that information. Surency Life & Health is committed to upholding the security and confidentiality of all personal information. Systems and procedures have been implemented in order to comply with HIPAA privacy, security and electronic transaction standards.
Health Care Reform
The recent Health Care Reform legislation has a significant impact on the health care industry. Surency Life & Health continually monitors health care legislation and makes changes and updates as needed to ensure compliance with new laws and regulations.
Fraud & Abuse
The Surency Life & Health Fraud & Abuse Hotline provides our constituents with a means to anonymously report suspected fraud and/or abuse. To report any suspected fraud or abuse, call 316-462-3343, toll-free 877-264-9381, or email firstname.lastname@example.org.