Privacy, Data Collection and Confidentiality Policy
Purpose
- Your privacy is important to OACANP. So we’ve developed a Privacy Policy that covers how we collect, use, disclose, transfer, and store your information. Please take a moment to familiarize yourself with our privacy practices and let us know if you have any questions. We will abide by the statements made in this Notice. Except as permitted by law and as explained in this Notice, we do not disclose any information about our past, present or future customers to anyone. When we use the term "Customer Information," we are referring to financial or health information that is "nonpublic," including any information from which a judgment could possibly be made about you. When we use the term "Protected Health Information" or "PHI," we are referring to individually identifiable oral, written and electronic information concerning the provision of, or payment for, health care to you. We refer to Customer Information and PHI collectively as "Private Information."
What information do we collect?
In providing your Navigator Service, we collect Customer Information and PHI from the following sources:
- Information we receive from you or your policyholder on applications, other forms or Web sites we sponsor.
- Information we obtain from your transactions with us, our affiliates or others, such as translators and family authorized family Members.
- Information we receive from consumer reporting agencies or others, such as Medicare, state regulators and law enforcement agencies.
Verification and the Federal Data Services Hub
The Marketplace will determine a consumer’s eligibility for health coverage and financial assistance for a premium tax credit and/or cost-sharing reductions using information from a consumer's application.
The Centers for Medicare & Medicaid Services (CMS) uses a system called the Federal Data Services Hub (the Hub) to verify that the information entered in the application is correct. The Hub provides a single secure connection between state and federal systems to trusted data sources to verify specific information in consumers' applications.
The Hub isn’t a database. It does not retain or store data. It’s a routing tool to securely send information from various trusted government databases through secure networks.
How do we protect Private Information?
Our employees are trained on the need to maintain your Private Information in the strictest confidence. They agree to be bound by that promise of confidentiality and are subject to disciplinary action if they violate that promise. We also maintain appropriate administrative, technical and physical safeguards to reasonably protect your Private Information. Finally, in those situations where we rely on a third party to perform business, professional or insurance services or functions for us, that third party must agree to safeguard your Private Information. That business associate must also agree to use it only as required to perform its functions for us and as otherwise permitted by our contract and the law. In these ways, we carry out our confidentiality commitments to you.
When must we seek your authorization before disclosing Private Information?
There may be circumstances where we will seek your authorization before making a disclosure of your Private Information. This is to ensure that we have your permission to make that disclosure. For example, you may have asked someone who is not your personal representative to contact us on your behalf to obtain information about your claims. Before we disclose your Private Information to that person, we would seek your authorization to do so, unless otherwise permitted or described in this Notice.
If you give us your authorization, you are permitted to revoke that authorization at any time in writing. We will honor your revocation once it is processed, except to the extent that we have taken action in reliance upon your original authorization.
Uses and disclosures of Private Information that do not require authorization
Most of our routine use and disclosure of your Private Information occurs in assisting you with enrolling into a health plan through the exchange.
Please note that we will limit the disclosure of certain information in accordance with laws governing the special nature of the information (e.g., HIV/AIDS, substance abuse, genetic information). Where a state permits minors of a certain age or status to seek treatment without parental consent, information that would normally be provided to our customers may be limited, that is because we must protect the privacy of that minor’s information in accordance with those state laws.
Payment Activities
We routinely use and disclose Private Information in connection with your health care coverage, to determine your eligibility for coverage and benefits, and to see that the treatment and services you receive are properly billed and paid. To do this, we may share Private Information with health care providers, their billing agents, insurance companies, and others
Disclosures to Family Members
Unless you notify us in writing otherwise, we may disclose your Private Information to a family member, close personal friend, the subscriber of your health benefits plan, or any person who is involved in your care or payment for that care. We can only disclose your Private Information that is relevant to that person’s involvement with your care or payment for that care. In the context of spouse-to-spouse (or between civil union partners) and parent-to-child relationships, including both minor and adult children, we will deem the spouse/civil union partner or parent on their coverage to be the personal representative of the other spouse/civil union partner or the child, as applicable. We will do this unless you notify us in writing that you do not wish that individual to serve as your personal representative. Contact Member Services as described in this Notice to designate or terminate a personal representative involved in your care or coverage.
Additional Reasons for Disclosure
We may also use or disclose Private Information to:
- Military authorities, if you are or were a member of the armed forces
- Further public safety or, when requested by federal officials, for national security or intelligence activities or for the protection of public officials;
- Appropriate bodies for public health activities, including the reporting of child abuse or neglect, adverse events, product defects, or for Food and Drug Administration reporting
- A health oversight agency for activities such as audits, investigations, licensure, disciplinary actions, or civil, administrative or criminal proceedings. These disclosures are necessary for the government to oversee the health care system and government benefits programs, as well as for compliance with standards and civil rights laws
- Carry out appropriate research, but only as expressly permitted and limited by the federal privacy rules;
- Communicate with members, legislators and regulators about legislative and regulatory developments and proposals that may impact access to affordable, quality health care;
- Contact you for fundraising purposes;
- Appropriate bodies in response to a subpoena or court order, or in response to litigation that directly involves us, the exchange or your group health plan
- A correctional institution or law enforcement agency, if you are an inmate or in the custody of law enforcement
- Conduct permissible marketing type activities, either ourselves or through other companies on our behalf, such as for health-related products or services, or to other financial and health institutions with which we have joint marketing agreements.
- Perform other functions and activities, as permitted by the federal privacy rules.
You should understand that, except as permitted or described in this document, we will not disclose your Private Information without a written authorization from you. And except for disclosures of PHI made directly to you or your personal representative the federal rules require us to use and disclose only the minimum PHI necessary to accomplish our purpose.
Legal Rights Related to Private Information
- The federal privacy rules entitle you to request access, inspection and copying of your PHI that we maintain about you that is included in what is called a "designated record set." But we are not required to maintain it, except for certain documentation related to privacy rules compliance or as may otherwise be required by law.
You may have a state law right to request, in writing, to inspect and obtain a copy of Customer Information about you. This does not include information that relates to, and is collected in connection with or in anticipation of, a claim or civil or criminal proceeding involving you. It also does not include information which we are prohibited by law from releasing. You must reasonably describe the information you seek in your written request, and the information must be reasonably locatable and retrievable by us. We may charge you a fee to cover the cost of providing this Customer Information.
- The federal privacy rules create a right to request amendment of your PHI included in the designated record set. We may deny your request under those rules if we determine that our records are accurate and complete or were not created by us, the information is not contained in our designated record set, or access is otherwise restricted by law.
You may have a state law right to request, in writing, to inspect and obtain a copy of Customer Information about you. This does not include information that relates to, and is collected in connection with or in anticipation of, a claim or civil or criminal proceeding involving you. It also does not include information which we are prohibited by law from releasing. You must reasonably describe the information you seek in your written request, and the information must be reasonably locatable and retrievable by us. We may charge you a fee to cover the cost of providing this Customer Information.
- The federal privacy rules create a right to request amendment of your PHI included in the designated record set. We may deny your request under those rules if we determine that our records are accurate and complete or were not created by us, the information is not contained in our designated record set, or access is otherwise restricted by law.
State law may entitle you to request that we amend or delete Customer Information about you in our records if you believe the information is incorrect or incomplete. We may deny this request. However, if we do so, we must advise you of the reasons for the denial and advise you of your right to file a statement of rebuttal.
- The federal privacy rules entitle you to request restrictions on our use and disclosure of PHI for health plan options. We will consider each request, but are not required to agree to any restrictions, except a reasonable request for confidential communications.
- The federal privacy rules entitle you to request to receive confidential communications of PHI if disclosing this information by the usual means could endanger you. We will accommodate all reasonable requests, subject to the restrictions and capabilities of our information processing systems. A verbal request may be considered, but must be followed up in writing.
- The federal privacy rules entitle you to request to receive an accounting of certain disclosures of your PHI made by us, such as disclosures to health oversight agencies.
If you wish to exercise any of the legal rights described in this Notice, you must do so in writing. To obtain further information about these rights, or if you would like to make such a request, please contact:
OACANP at OACANP@gmail.com
Complaints
You may file a complaint with OACANP if you feel that your privacy rights have been violated. All complaints must be submitted in writing. A verbal complaint will be processed, but we request that it be documented in writing. To file a complaint, contact:
OACANP at OACANP@gmail.com
You may also complain to the U.S. Secretary of Health and Human Services, who is responsible for overseeing compliance with the federal privacy law. You will not be retaliated against for filing a complaint. If you have any questions or comments about this Notice, or want to request another copy of it, you can call 973-500-6031 x. 103 or visit our website at www.OACANP.com
