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.
On January 1, 2021, our plan name will change from Health Choice Generations to Health Choice Pathway.
Health Choice Generations HMO SNP (Health Choice) is your Medicare Advantage Special Needs Plan with prescription drug coverage (MA-PD).
We are required by law to maintain the privacy of your medical information. This Notice describes how we handle your medical information and protect that information. This Notice also explains your rights about your medical information.
How We May Use and Disclose Medical Information About You:
Treatment – We may use and disclose medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, or other hospital personnel involved in taking care of you.
Payment – We may use and disclose medical information about you so that providers from whom you receive treatment and services may receive payment. Examples of payment activities include: billing, claims management and other related administrative functions.
Health care operations – We may use and disclose medical information about you for our health care operations. These uses and disclosures are necessary to run Health Choice and make sure that you and others we cover receive quality care. For example, we may use medical information to review the treatment and services rendered by a provider to evaluate the provider’s performance.
When required by law – We will share medical information about you if uses or disclosures are required to comply with the law.
Public health and safety and government requests or functions – We may disclose your medical information for purposes such as the following and as required by law:
- Abuse, neglect, and domestic violence reports, including child abuse or neglect;
- Food and Drug Administration reporting requirements related to quality, safety or effectiveness;
- Preventing or controlling disease, injury or disability, including reports of disease, injury, births or deaths;
- Immunizations and blood lead levels;
- Workers’ compensation programs for work-related illnesses or injuries; and
- Military, intelligence, and national security activities.
To prevent a serious threat to health or safety – We may use and disclose medical information about you when necessary to prevent or lessen a serious and imminent threat to the health and safety of the public or another person. Any disclosure would be limited to disclosure to someone able to help prevent or lessen the threat.
Health oversight activities – We may share medical information with the Centers for Medicare and Medicaid Services (CMS) or another health oversight agency for activities authorized by law. This could include audits, investigations, and inspections to review the health care system and how you get health care.
Health-related benefits or services – From time to time, we may use and share your medical information so that we may tell you about benefits or services available to you. This may include communications about our various health‑related products or services, such as our Arizona Health Care Cost Containment System (AHCCCS) plan, for which you may be eligible.
Lawsuits and disputes – We may share medical information about you to respond to a court order or an administrative order. We may also share medical information about you in response to a subpoena, discovery request, or other lawful process.
Law enforcement – We may release medical information to law enforcement officials in certain circumstances or as required by law, including the following circumstances:
- In response to a court order, subpoena, warrant, summons, administrative request or similar process; and
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Business associates – We may use or disclose your medical information to business associates that perform various activities, such as accounting or administrative services, on our behalf.
Notifications and individuals involved in your health care – We may use or disclose your medical information for purposes of coordinating disaster relief efforts and to notify or assist in the notification of a family member, personal representative or other person responsible for your care. We may disclose medical information about you to people outside of Health Choice who may be involved in your medical care, such as family members or others if the medical information is directly relevant to such person’s involvement with the individual’s health care or payment related to health care or is needed for notification purposes.
Research – We may use and disclose your medical information for research purposes.
Coroners, funeral directors, and medical examiners – We may disclose medical information to coroners, funeral directors, and medical examiners consistent with applicable law.
Organ, eye or tissue donations – We may use or disclose medical information to organ procurement organizations or other entities engaged in procuring, banking or transplanting cadaveric organs, eyes or tissue for the purpose of facilitating donation and transplantation.
Inmates – We may disclose your medical information to a correctional institution or a law enforcement official if you are an inmate or under the lawful custody of a law enforcement official.
State or other laws – We may use or disclose substance abuse treatment information in accordance with applicable state and federal laws, such as Title 42, Code of Federal Regulations, Part 2. We will follow Arizona’s statutes regarding Insurance Information and Privacy Protection, Genetic Testing, Insurance Procedures Relating to HIV Information, and other applicable laws.
When Your Written Permission (Authorization) Is Required for Other Uses and Disclosures:
We will obtain your written permission prior to the use or disclosure of your medical information anytime the law does not allow us do so without your permission and for a purpose other than listed above. For example, the law requires us to get your permission for the following types of medical information and purposes:
- Psychotherapy notes – If we hold these notes, we will make certain uses or disclosures of these notes to others only if we have your permission;
- For marketing purposes; and
- For the sale of your medical information.
If you provide us with written permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time, except to the extent that we have taken action in reliance on your permission or if the authorization was obtained as a condition of obtaining insurance coverage and another law provides us with the right to contest a claim under the policy or the policy itself. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. We are unable to protect information that has already been disclosed with your permission
Your Rights Regarding Your Medical Information:
Right to look at and copy your medical information – You have the right to look at and copy medical information that may be used to make decisions about your medical care, including the review of treatment requests and claims from your doctors. Usually, this includes a paper or electronic copy of your records and/or bills that providers send to us. If you want to ask us for a copy, write to our Privacy Officer at the address at the end of this Notice. We may charge you a fee for our postage and labor costs and supplies to create the copy. There may be times when we may deny your request to look at or copy your medical information. If that happens, you have a right to submit a request in writing and ask us to review our decision to deny your request.
Right to amend your medical information – If you feel that your medical information is incorrect or incomplete, you can ask us to change that information. To ask us to change your information, write to our Privacy Officer at the address at the end of this Notice. Please tell us clearly what you information you want to change. If we deny your request, we will provide you with the reason for the denial.
For any medical information created by your health care provider (i.e., doctor, hospital, clinic, etc.), please send a request to change your information to that individual or entity directly.
Right to request restrictions – You have the right to ask us to restrict or limit how we use or disclose your medical information for treatment, payment, or health care operations. For example, you may ask us not to disclose that you have had a particular surgery or treatment. You may also ask that we restrict the disclosure of your medical information to your relatives, close personal friends or others that are involved with your care. To ask us to restrict your information, write to our Privacy Officer at the address at the end of this Notice. Please tell us: what information you want to limit; whether you want to limit its use, disclosure, or both; and to whom you want the limits to apply.
We are not required to agree to your request, except for requests to restrict disclosures for purposes of payment or health care operations when you have paid in full out-of-pocket for a health care item or service covered by the request and when the disclosure is not required by law. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
Right to confidential communications – You have the right to ask us to communicate with you only in writing or at a certain address or phone number if you think the normal way we communicate will be dangerous to you. To ask us for confidential communication, write to our Privacy Officer at the address at the end of this Notice. Please tell us: how our normal way of communicating with you is dangerous to you; how or where you wish to be contacted; and what information is to be communicated in this manner. We must accommodate reasonable requests if you tell us that the disclosure of your medical information could endanger you.
Right to accounting of disclosures – You have a right to ask us for a list of people or groups to whom we have disclosed your medical information. This is called an accounting of disclosures and includes the dates your medical information was disclosed, the reasons for the disclosures, and the types of medical information disclosed. To ask us for a list, write to our Privacy Officer at the address at the end of this Notice. Tell us the period of time for which you want a list of disclosures. The list will not include some types of disclosures, such as: disclosures we made to you, those we made with your permission or those we made for our treatment, payment or health care operations activities.
Right to a paper copy of this notice – You have the right to a paper copy of this Notice. To ask us for a paper copy, write to our Privacy Officer at the address at the end of this Notice or contact our Member Services Department at call us at:1 (800) 656-8991 (8AM to 8PM, 7 days of week). If you have trouble hearing, call TTY/TTD: 711. This Notice is available in a printable format below.
We may change this Notice. The changes to the Notice will apply to medical information we already have about you, as well as any information we get in the future. If we do change the Notice, we will provide you with the new Notice by posting it online at the above web address or mailing it to you, upon request. You will always know which one is the most current because we print the effective date of the Notice on the top of the front page. We are required to abide by the terms of the Notice currently in effect and to give you this Notice.
Breaches – We are required by law to notify affected individuals following a breach of unsecured medical information.
Complaints – You have the right to file a complaint if you believe your privacy rights have been violated. To file a complaint, write to our Privacy Officer at the address at the end of this Notice. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.
Questions – If you have any questions about this Notice, contact our Privacy Officer. Your medical treatment providers (i.e., doctors, hospitals, home health agencies, etc.) may have different policies or notices about the use and sharing of your medical information. If you have questions about your provider’s privacy policies, please contact your provider directly.
How to contact our Privacy Officer: Write to – Health Choice Privacy Officer / 410 N. 44th Street, Ste. 900 / Phoenix, AZ 85008. Or call us at: 1 (800) 656-8991 (8AM to 8PM, 7 days of week). If you have trouble hearing, call TTY/TTD: 711.