Dear Health Plan Member:
As a participating member of one or more of the Connecticut Teacher Retirement Board (TRB) health plans, you entrust us and/or our agents with certain personal information about yourself. We want you to know: 1) how we protect your privacy and your rights, and 2) our responsibilities regarding recorded information about you. This recorded information is known as Protected Health Information (PHI). We will not use or disclose your PHI without your permission, except as described below.
- A record is made each time you visit a physician, or other healthcare provider. Typically this record is a legal document that contains your symptoms, examinations and test results, diagnoses, treatments, and plans for future care. Federal and state laws allow us to disclose the minimum necessary private health information (PHI) for treatment, payment, or healthcare operations.
- For Planning Your Care and Treatment, as documentation of care you received, and as a means of communication among the many health professionals who contribute to your care.
- For Payment and treatment of services you receive.
- Verification of Services as a means by which you can verify that services billed were actually provided.
- For Health Care Operations used as a tool in educating health professionals.
For Public Health Officials used as a source of information charged with improving the health of the nation.
- Legal Actions if used to defend a legal action brought by an individual.
- As Required by Law for judicial and administrative proceedings pursuant to legal authority; to report information related to victims of abuse, neglect or domestic violence; and to assist law enforcement officials in their duties.
- With Your Authorization as a source of data for medical research or facility planning; as a tool with which we can access and continually work to improve the outcomes we achieve; to better understand who, what, when, where and why others may access your health information; and to make more informative decisions when authorizing disclosures to others.
- Maintain the privacy of your protected health information;
- Provide you with a notice of our legal duties and privacy practices with respect to information we collect and maintain about you;
- Abide by the terms of this notice;
- Notify you if we are unable to fulfill a request in relation to your PHI; and
- ccommodate reasonable requests you may have to communicate health information by alternative means and/or at alternative locations. For example, rather than contacting you in writing at home, you may request we contact you at work.
You have the right to:
- Request a restriction on certain uses and disclosures of your information as provided by 45 CFR part 164.522, however, the TRB is not required to agree to a requested restriction;
- Obtain a paper copy of the notice of information practices upon request;
- Inspect and obtain a copy of your health record as provided for in 45 CFR part 164.524;
- Request that TRB amend your health record for as long as TRB maintains the record, as provided in 45 CFR part 164.526;
- Request communications of your health information by alternative means or at alternative locations;
- Revoke your authorization to use or disclose health information except to the extent that action has already been taken; and
- Receive an accounting of disclosures or amendments made of your health information as provided by 45 CFR, part 164.528.
- We may impose a reasonable fee for:
Copying, including cost of supplies and labor;
Preparing an explanation or summary of the requested PHI.
If you believe your privacy rights have been violated, your may direct your complaint to TRB by contacting:
CTRB, HIPAA Privacy Officer
765 Asylum Avenue
Hartford, CT 06105-2822
We may change our practices and make the new provisions effective for all PHI we maintain. Should our practices change, we will mail a revised notice to you. Except when required by law, a material change to any term of the notice may be implemented prior to the effective date of the revised notice.
HIPAA Privacy Officer