Blue Ridge Bank Benefit Plan
NOTICE OF HIPAA 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.
The Blue Ridge Bank Benefit Plan (the "Plan") is
required by the Health Insurance Portability and Accountability
Act ("HIPAA") to protect the privacy of your personal
health information held by the Plan. The Plan provides health
and/or dental benefits to you through one or more health care
related benefit programs described in your summary plan
description(s). The Plan is sponsored by Blue Ridge Bank (the "Company").
The Plan receives and maintains your personal health information in
the course of providing these benefits to you. The Plan hires
business associates, such as Blue Cross Blue Shield of South
Carolina and the South Carolina Bankers Employee Benefit Trust, to
help it provide these benefits to you. These business associates
also receive and maintain your personal health information in the
course of assisting the Plan.
THE EFFECTIVE DATE OF THIS NOTICE IS APRIL 14, 2004. The Plan is
required to follow the terms of this notice until it is replaced.
The Plan reserves the right to change the terms of this notice at
any time. If the Plan makes significant changes to this Notice,
the Plan will revise it and send a new notice at that time. The
Plan reserves the right to make the new changes apply to all your
personal health information maintained by or for the Plan before
and after the effective date of the new notice.
General Privacy Standard.
Under HIPAA, the Plan and its business
associates may use or give out ("disclose") your
personal health information without your authorization (written
permission) for the purposes described below unless there is a
state or federal law that provides you with greater protection of
your privacy rights than HIPAA. For example, state or federal law
may require that the Plan take additional precautions before using
or disclosing certain types of health information such as mental
health records, alcohol or substance abuse records, or
prescription information. State or federal law may also give you
greater access to your personal health information than HIPAA.
The Plan will make every effort to comply with the requirements of the
applicable state or federal law and HIPAA. This means that
regardless of which law applies, your health information will be
afforded the greatest level of privacy protection and you will be
granted the most access to your health information.
Purposes for which the Plan May Use or Disclose Your Personal Health
Information Without Your Permission or An Opportunity to Agree or
Object.
The Plan and its business associates may use or
disclose your personal health information without your
authorization or an opportunity to agree or object for the
purposes described below. The Plan and its business associates
have their own policies and procedures to ensure these uses or
disclosures are limited to the minimum amount of your personal
health information reasonably necessary to accomplish the
described purpose.
-
Payment.
The Plan has the right to use and disclose your personal health
information to make decisions about payment for your health care.
"Payment" includes a variety of activities, including
decisions about your eligibility or coverage; processing claims
(including paying claims and seeking payment from other
responsible third parties); reviewing medical necessity,
coverage, appropriateness of care and support for charges;
conducting utilization review(precertification, concurrent or
retrospective reviews) ; and making limited disclosures to
collection or credit reporting agencies concerning your payment
of premiums. Examples: The Plan reviews and uses information
about treatment you have received to determine whether that
treatment is covered under a Benefit Program and whether to pay
or deny a claim. The Plan also uses your personal health
information to make decisions when you or your health care
provider appeals the denial of a claim.
- Health
Care Operations. The Plan has the right to use and
disclose your personal health information to conduct its health
care operations. "Health Care Operations" of the Plan
include quality improvement activities, case management and care
coordination and evaluating Plan performance. They also include
accreditation, licensure or credentialing activities. The Plan
also conducts activities related to creating, renewing or
replacing Benefit Programs or contracts for those programs. The
Plan performs or contracts for audit, fraud detection and
compliance services. The Plan also does business planning and
development for the Plan and its Benefit Programs (including
developing or improving benefits, payment methods and coverage
policies), along with general business management and
administrative activities. The Plan may also use your personal
health information to contact you about other health-related
benefits and services offered by the Plan. Examples: The Plan may
use or disclose your personal health information for the purpose
of coordinating your care to reduce the cost of your care. The
Plan may also use or disclose your personal health information
when it is evaluating the financial performance of the Plan or
any of its Benefit Programs, or deciding whether to offer or
continue offering certain benefits.
- To
Business Associates. The Plan may disclose your personal
health information to those business associates with whom the
Plan contracts to assist the Plan in performing the payment and
health care operations activities of the Plan and its Benefit
Programs such as Blue Cross Blue Shield of South Carolina and the
South Carolina Bankers Employee Benefit Trust. Each business
associate of the Plan must agree in writing to ensure the
continuing privacy and security of your personal health
information it creates, receives or uses. Certain business
associates may have the only copies of your personal health
information, and will assist the Plan in carrying out its
responsibilities with regard to your rights to access and amend
that information. These rights are described below.
- To
the Company as Plan Sponsor.
- The
Plan may disclose to the Company as the Plan sponsor claims
history and other similar information. This will be summary
information that does not disclose your name or other
distinguishing characteristics. The Plan may also disclose to the
Company as Plan sponsor the fact that you are enrolled in, or
disenrolled from the Plan or any of its Benefit Programs.
- The
Plan may disclose your personal health information to certain
designated employees of the Company whose job responsibilities
include assisting the Plan in performing payment and health care
operations activities for the Plan and its Benefit Programs. The
Company has agreed to ensure the continuing privacy and security
of your personal health information. The Company has also agreed
not to routinely use or disclose your personal health information
for employment-related activities or for the purpose of
administering any other benefit plans that are exempt from the
HIPAA privacy regulations.
- Required
by Law. The Plan may use or disclose your personal health
information to the extent required by law. These laws include any
applicable federal, state or local laws that would require the
Plan or its business associates to make a specific use or
disclosure of your personal health information. The way these
disclosures are made and the amount and type of personal health
information disclosed will be limited to the legal requirement.
In certain cases the Plan may be required to notify you that a
disclosure has been or will be made.
- Public
Health and Health Oversight Activities. The Plan may
disclose your personal health information to public health
authorities that are authorized by state, federal or local law to
collect information for purposes such as preventing or
controlling disease, injury or disability or notification of
exposure to communicable diseases. The Plan may also disclose
your personal health information to a federal, state or local
agency required by law to oversee, license, inspect or
investigate programs where health related information is
collected or used.
- Lawsuits
or Similar Proceedings. The Plan may disclose your
personal health information in response to a court order or an
administrative order. The Plan may also disclose your personal
health information in response to a subpoena or other type of
lawful request from an attorney involved in a lawsuit, or from a
government agency or investigator involved in an administrative
proceeding. In the case of a subpoena or other lawful request,
the Plan is required to make sure you are aware of the request or
obtain an assurance that your personal health information will be
used appropriately.
- Law
Enforcement. The Plan may disclose your relevant personal
health information in response to a court ordered warrant,
subpoena or summons; a grand jury subpoena; or a civil
investigative demand made by an agency or officer for legitimate
law enforcement inquiry.
- Coroners
and Medical Examiners. The Plan may disclose your
personal health information to a coroner or medical examiner for
purposes of identifying a deceased person or determining the
cause of death.
- Organ,
Eye or Tissue Donation. The Plan may disclose your
personal health information to facilitate organ, eye or tissue
donation or transplantation as allowed by the state's organ
procurement laws.
- Threats
to Public Health. The Plan may be required to disclose
limited personal health information to the extent the Plan in
good faith determines such disclosure is necessary to prevent or
lessen a serious and imminent threat to public health or safety,
or to the health or safety of a specific individual.
- Specialized
Government Functions. The Plan may be required to
disclose your personal health information to the United States or
a State government if you are an active or veteran member of the
military, seeking a government security clearance or permission
to travel abroad, if you are in lawful custody, or if the
government requires such information to conduct lawful national
security activities.
- Worker's
Compensation. The Plan may disclose your personal health
information as authorized by the state's workers compensation
laws.
Purposes
for which the Plan Must Give You and Opportunity to Agree or
Object to Us Disclose Your Personal Health Information.
The Plan may disclose personal health information related to
payment for your health care under the Plan to your family
members, other relatives or anyone else identified by you as
involved in your care in the following circumstances:
- If
you bring the individual with you to discuss an issue arising
from payment for your health care under the Plan, unless you
object or notify us otherwise at the time we may infer from their
presence that you agree we may discuss your personal health
information with that individual;
- If
you are incapacitated or in a situation such as a medical
emergency and cannot agree or object, we may disclose your
personal health information to your personal representatives to
assist them in obtaining payment for your health care; or
- If
you sign an authorization specifically allowing the Plan to
disclose your personal health information to such an individual.
Uses
and Disclosures with Your Written Permission (Authorization).
The Plan will not use or disclose your personal health information
for any purposes other than those described above unless you give
your written permission ("authorization") to do so,
using a form approved or supplied by the Plan or its business
associate. If you give a valid written authorization to use or
disclose your personal health information then, in most cases, you
may revoke it in writing at any time. Your revocation will be
effective for all the personal health information the Plan and its
business associates maintain, unless the information has already
been disclosed in reliance on your prior written authorization.
Except in limited eligibility and enrollment circumstances, your
right to receive benefits under the Plan cannot be conditioned
upon your signing an authorization allowing the Plan to use or
disclose your personal health information in a manner not
described in this Notice.
Your
Rights. You may make a written request to the Plan to do
one or more of the following concerning your personal health
information that the Plan maintains:
To
put additional restrictions on the Plan's use and disclosure of
your personal health information. The Plan does not have to agree
to your request.
To
ask the Plan communicate with you in confidence about your
personal health information by a different means or at a
different location than the Plan is currently using. The Plan
does not have to agree to your request unless necessary to avoid
endangering you. Your request must specify the alternative means
or location to communicate with you in confidence.
To
see and get copies of your personal health information that is
created or maintained by the Plan or its business associates. In
limited cases, the Plan does not have to agree to your request.
To
correct your personal health information that is created or
maintained by the Plan. In some cases, the Plan does not have to
agree to your request.
To
receive a list of disclosures of your personal health information
that the Plan and its business associates made for the last 6
years (but not for disclosures made before April 14, 2004). The
Plan is not required to list disclosures made for treatment,
payment or health care operations, or disclosures made with your
authorization.
- To
send you a paper copy of this notice if you received this notice
by e-mail or on the internet.
If
you want to exercise any of these rights described in this Notice,
please contact the designated Plan Contact at the address provided
below. The Plan Contact will give you the necessary information
and forms for you to complete and return. In some cases, the Plan
may charge you a nominal, cost-based fee to carry out your
request.
Complaints.
If you believe your privacy rights have been violated by the Plan,
you have the right to complain to the Plan or to the Secretary of
the U.S. Department of Health and Human Services. You may file a
complaint with the Plan Contact designated below, or ask for the
address of the appropriate regional office of the Secretary of the
USDHHS. Neither the Plan nor the Company will retaliate against
you if you choose to file a complaint.
Contact
Office. To request additional copies of this notice or to
receive more information about our privacy practices or to
exercise any of your rights, including your right to file a
complaint, please contact us at the following
Contact
Office:
Privacy
Officer
c/o South Carolina
Bankers Association
Telephone:
803-779-0850 Fax: 803-256-8150
E-mail:
teresataylor@scbankers.org
Address:
P.0.
Box 1483
Columbia, South Carolina 29202