CONTENTS
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. The rights described in this Notice apply to you, your spouse, and your dependents. It also describes your rights to access and control your protected health information and the Plan’s duties if this information is improperly accessed or disclosed. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
This Plan is required to abide by the terms of this Notice of Privacy Practices. The terms of the notice may be changed at any time. The notice is effective for all protected health information maintained at that time. The Plan will provide you with a Notice of Privacy Practices if you call the Fund Office and request that a copy be sent to you in the mail.
If you have any questions about this notice, please contact:
Privacy Official
Electrical Welfare Trust Fund
10003 Derekwood Lane, Suite 130
Lanham, MD 20706-4811
301-731-1050 or
1-800-929-EWTF (3983)
How the Plan May Use or Disclose Your Health Information
The following categories describe the ways that the Plan may use and disclose your health information. For each category of uses and disclosures, you will receive an explanation as to what is meant, and some examples will be presented. Not every use or disclosure in a category will be listed. However, all the ways that the Plan is permitted to use and disclose information will fall within one of the following categories:
Payment Functions
The Plan may use or disclose health information about you for payment functions. This includes, but is not limited to, functions such as to determine eligibility for plan benefits, obtain premiums, facilitate payment for the treatment and services you receive from health care providers, determine plan responsibility for benefits, and to coordinate benefits. For example, payment functions may include reviewing the clinical guidelines for medical appropriateness of health care services, determining whether a particular treatment is experimental or investigational, or determining whether a treatment is covered under the plan.
Health Care Operations
The Plan may use and disclose health information about you to carry out necessary insurance-related activities. Such activities may include underwriting, premium rating and other activities relating to plan coverage; conducting quality assessment and improvement activities; submitting claims for stop-loss coverage; disease or care management; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; and business planning, management and general administration. For example, health care operations functions may include referring you to a disease management or well-baby program, projecting future benefit costs, or reviewing the accuracy of the plan’s claims processing functions.
Required by Law
As required by law, the Plan may use and disclose your health information. For example, the Plan may disclose medical information when required by a court order or subpoena in a litigation proceeding such as a malpractice action. In addition, the Plan is required to give you access to certain health information when you request it. Further, the Plan may be required to use and disclose your health information to the Secretary of the Department of Health and Human Services for purposes of reviewing whether the Plan is in compliance with federal privacy regulations.
Public Health
As required by law, the Plan may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting abuse or neglect, including child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.
Health Oversight Activities
The Plan may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings related to oversight of the health care system.
Judicial and Administrative Proceedings
The Plan may disclose your health information when required in the course of any administrative or judicial proceeding, including a subpoena issued by any administrative agency or court.
Law Enforcement
The Plan may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
Coroners, Medical Examiners and Funeral Directors
The Plan may disclose the health information of a deceased pariticipant or dependent to coroners, medical examiners and funeral directors. For example, this may be necessary to identify a deceased person or determine the cause of death.
Organ and Tissue Donation
The Plan may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues, as necessary.
Public Safety
The Plan may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
National Security
The Plan may disclose your health information for military, national security, prisoner and government benefits purposes.
Workers’ Compensation
The Plan may disclose your health information when authorized by and as necessary to comply with workers’ compensation or similar laws.
Health Care Information
The Plan may contact you to give you information about health-related benefits and services that may be of interest to you.
Disclosures to Plan Sponsors
The Fund may disclose your health information to its Board of Trustees for purposes of administering the Plan. Any disclosure to the Trustees will be consistent with the Board of Trustees’ powers, duties, and responsibilities under the Fund’s Trust Agreement. The Trustees are bound by the Fund’s privacy policies and procedures and may not re-disclose protected health information other than as permitted or required by the Plan and applicable law.
The Fund’s privacy official shall be responsible for advising a Trustee of any perceived violation of the Fund’s privacy policies and procedures. In the event the matter is not resolved to the satisfaction of the Fund’s privacy official, the privacy official shall refer the matter to the Chairman of the Fund (or to the Co-Chairman if the Chairman is involved in the perceived violation), and if matter still is not resolved, to the full Board of Trustees. The Trustees certify that they have agreed to foregoing with respect to disclosure of protected health information.
When The Plan May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, the Plan will not use or disclose your health information without written authorization from you. If you do authorize the Plan to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. If you revoke your authorization, the Plan will no longer be able to use or disclose health information about you for the reasons covered by your written authorization, though the Plan will be unable to take back any disclosures that have already been made with your permission.
When EWTF Must Provide You a Breach Notification
If your protected health information is used, accessed, or disclosed in a manner not described in this Notice of Privacy Practices, we will investigate the “breach” and take available steps to mitigate the harm. In addition, if we determine that the breach poses a significant risk of financial, reputational, or other harm, we will send a “breach notification” notice to you and any other affected individual within 60 days of the breach. The breach notification notice will: (1) briefly describe the breach; (2) describe the types of protected health information that were disclosed; (3) describe the steps to take to protect yourself from potential harm caused by the breach; (4) describe what we are doing to investigate and mitigate the breach and to prevent future breaches; and (5) instruct you to contact us.
Disclosure of Your Health Information to Family Members
Unless you request otherwise, the Plan will disclose your health information to your spouse and dependents if the information is directly relevant to payment for health care by the Plan.
Statement of Your Health Information Rights
Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures of your health information. EWTF is not required to agree to the restrictions that you request. If you would like to make a request for restrictions, you must submit your request in writing to:
Privacy Official
Electrical Welfare Trust Fund
10003 Derekwood Lane, Suite 130
Lanham, MD 20706-4811
301-731-1050 or
1-800-929-EWTF (3983)
Right to Request Confidential Communications
You have the right to receive your health information through a reasonable alternative means or at an alternative location. To request confidential communications, you must submit your request in writing to:
Privacy Official
Electrical Welfare Trust Fund
10003 Derekwood Lane, Suite 130
Lanham, MD 20706-4811
301-731-1050 or
1-800-929-EWTF (3983)
The Plan is not required to agree to your request.
Right to Inspect and Copy
You have the right to inspect and copy health information about you that may be used to make decisions about your Plan benefits. To inspect and copy such information, you must submit your request in writing to:
Privacy Official
Electrical Welfare Trust Fund
10003 Derekwood Lane, Suite 130
Lanham, MD 20706-4811
301-731-1050 or
1-800-929-EWTF (3983)
The Plan must act on your request within 30 days if the information is maintained on site or within 60 days if it is maintained offsite. A 30-day extension is allowed. If your request is denied, you will be provided with a written denial setting forth the basis for the denial, a description of how you may exercise those review rights, and a description of how you may complain to the Secretary of the Department of Health and Human Services.
If you request a copy of the information, the Plan may charge you a reasonable fee to cover expenses associated with your request.
Right to Request Amendment
You have a right to request that the Plan amend your health information that you believe is incorrect or incomplete. The Plan is not required to change your health information and if your request is denied, you will be provided with information about the denial and how you can disagree with the denial.
The Plan must act on your request within 60 days. A 30-day extension is allowed.
To request an amendment, you must make your request in writing to:
Privacy Official
Electrical Welfare Trust Fund
10003 Derekwood Lane, Suite 130
Lanham, MD 20706-4811
301-731-1050 or
1-800-929-EWTF (3983)
You must also provide a reason for your request.
Right to Accounting of Disclosures
You have the right to receive a list or “accounting of disclosures” of your health information made by the Plan, except that the Plan does not have to account for disclosures made for purposes of payment functions or health care operations, made to you, or made pursuant to a written authorization signed by you or your personal representative. To request this accounting of disclosures, you must submit your request in
writing to:
Privacy Official
Electrical Welfare Trust Fund
10003 Derekwood Lane, Suite 130
Lanham, MD 20706-4811
301-731-1050 or
1-800-929-EWTF (3983)
Your request should specify a time period of up to six (6) years and may not include dates before April 14, 2003. The Plan will provide one list per 12-month period free of charge; you may be charged for additional lists. The Plan must act on your request within 60 days. A 30-day extension is allowed if you are told why the delay is necessary and when the accounting will be available.
Right to Paper Copy
You have a right to receive a paper copy of this Notice of Privacy Practices at any time. To obtain a paper copy of this Notice, send your written request to:
Privacy Official
Electrical Welfare Trust Fund
10003 Derekwood Lane, Suite 130
Lanham, MD 20706-4811
301-731-1050 or
1-800-929-EWTF (3983)
If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact:
Privacy Official
Electrical Welfare Trust Fund
10003 Derekwood Lane, Suite 130
Lanham, MD 20706-4811
301-731-1050 or
1-800-929-EWTF (3983)
Changes to this Notice of Privacy Practices
The Plan reserves the right to amend this Notice of Privacy Practices at any time in the future and to make the new Notice provisions effective for all health information that it maintains. The Plan will promptly revise the Notice and distribute it to you whenever material changes are made to the Notice. Until such time, the Plan is required by law to comply with the current version of this Notice.
Personal Representatives
You may exercise your rights through a personal representative, who will be required to produce evidence of his or her authority to act on your behalf before he or she will be given access to your health information or allowed to take any action for you. Proof of such authority may take one of the following forms:
- A notarized power of attorney for health care purposes; or
- A court order of appointment of the individual as your conservator or guardian.
Unless you request otherwise the Plan will consider the following individuals your personal representative, but will always request verification of identity prior to disclosing health information:
- A parent of an unemancipated minor child; or
- Your spouse.
If you wish to restrict access to your health information, see the “Right to Restriction” provision above.
The Plan may deny access to a personal representative if such action is necessary to protect your rights.
Complaints
Complaints about this Notice of Privacy Practices, about how the Plan handles your health information, or about how the Plan handles its breach notification obligations, should be directed to:
Privacy Official
Electrical Welfare Trust Fund
10003 Derekwood Lane, Suite 130
Lanham, MD 20706-4811
301-731-1050 or
1-800-929-EWTF (3983)
The Plan will not retaliate against you in any way for filing a complaint. All complaints to the Plan must be submitted in writing. If you believe your privacy rights (including your breach notification rights) have been violated, you may file a complaint with the Secretary of the Department of Health and Human Services and mail it to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Building
Room 509F HHH Building
200 Independence Ave., SW
Washington, DC 20201
You also may address your complaint to one of the regional Office for Civil Rights. A list of these offices can be found online at www.hhs.gov/ocr/office/about/rgn-hqaddresses.
Federal Regulations
The federal government regulates the use and disclosure of health information. These regulations are at 45 Code of Federal Regulations Parts 160 and 164. This Notice summarizes your rights under these regulations. The regulations will supersede any discrepancy between the information contained in this notice and the regulations.