Privacy Policy

IMPORTANT INFORMATION ABOUT YOUR PRIVACY RIGHTS
Notice Of Privacy Practices
Effective October 1, 2010*

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

New Century Health may conduct utilization review or provide other necessary services on behalf of your health plan/insurance carrier. New Century Health may require access to your health information in order to fulfill its duties, as explained more fully below. Please be assured that New Century Health respects the confidentiality of your health information.

We are required by federal and state laws to maintain the privacy of your health information and provide this notice. This notice explains how we use information about you and when we may share that information with others. It also informs you about your rights with respect to your health information and how you may exercise these rights.

We use security safeguards and techniques designed to protect your health information that we collect, use or disclose orally, in writing and electronically. We train our employees about our privacy policies and practices, and we limit access to your information to only those employees who need it in order to perform their business responsibilities. We do not sell information about enrollees or former enrollees.

How We Use or Share Information

We may use or share information about you for purposes of payment, treatment and health care operations, including with our business associates. For example:

Payment: We may use your information to process and pay claims for payment submitted to us by you or your doctors, hospitals and other health care providers in connection with medical services provided to you.

Treatment: We may share your information with your doctors, hospitals, or other providers to help them provide medical care to you. For example, if you are in the hospital, we may give the hospital access to any medical records sent to us by your doctor.

Health Care Operations: We may use and share your information in connection with our health care operations. These include, but are not limited to:

- Performing coordination of care with your health plan/carrier or health care providers.

- Conducting activities to improve the health or reduce the health care costs of health plan enrollees. For example, we may use or share your information with others to help manage your health care.

- Managing our business and performing general administrative activities, such as customer service and resolving internal grievances and appeals.

- Conducting medical reviews, audits, fraud and abuse detection, and regulatory compliance and legal services necessary to running our business.

- Conducting business planning and development, rating our risk and determining our premium rates, if any. However, we will not use your genetic information for underwriting purposes.

- Reviewing the competence, qualifications, or performance of our network providers, and conducting training programs, accreditation, certification, licensing, credentialing and other quality assessment and improvement activities.

Business Associates: We may share your information with others who help us conduct our business operations, provided they agree to keep your information confidential by signing a “Business Associate Agreement”.

Other Ways We Use or Share Information

We may also use and share your information for the following other purposes:

We may use or share your information with the employer or health-plan sponsor through which you receive your health benefits. We will not share individually identifiable health information with your benefits plan unless they promise to keep it protected and use it only for purposes relating to the administration of your health benefits.

We may share your information with a health plan, provider, or health care clearinghouse that participates with us in an organized health care arrangement. We will only share your information for health care operations activities associated with that arrangement.

We may share your information with another health plan that provides or has provided coverage to you for payment purposes.

We may also share your information with another health plan, provider or health care clearinghouse that has or had a relationship with you for the purpose of quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, or detecting or preventing health care fraud and abuse.

We may share your information with a family member, friend, or other person who is assisting you with your health care or payment for your health care. We may also share information about your location, general condition, or death to notify or help notify (including identifying and locating) a person involved with your care or to help with disaster-relief efforts. Before we share this information, we will provide you with an opportunity to object. If you are not present, or in the event of your incapacity or an emergency, we will share your information based on our professional judgment of whether the disclosure would be in your best interest.

State and Federal Laws Allow Us to Share Information

There are also state and federal laws that allow or may require us to release your health information to others. We may share your information for the following reasons:

We may report or share information with state and federal agencies that regulate the health care or health insurance system such as the U.S. Department of Health and Human Services, your State Insurance Department and your State Department of Health.

We may share information for public health and safety purposes. For example, we may report information to the extent necessary to avert an imminent threat to your safety or the health or safety of others. We may report information to the appropriate authorities if we have reasonable belief that you might be a victim of abuse, neglect, domestic violence or other crimes.

We may provide information to a court or administrative agency (for example, in response to a court order, search warrant, or subpoena).

We may report information for certain law enforcement purposes. For example, we may give information to a law enforcement official for purposes of identifying or locating a suspect, fugitive, material witness or missing person.

We may share information with a coroner or medical examiner to identify a deceased person, determine a cause of death, or as authorized by law. We may also share information with funeral directors as necessary to carry out their duties.

We may use or share information for procurement, banking or transplantation of organs, eyes or tissue.

We may share information relative to specialized government functions, such as military and veteran activities, national security and intelligence activities, and the protective services for the President and others, and to correctional institutions and in other law enforcement custodial situations.

We may report information on job-related injuries because of requirements of your state worker compensation laws.

Under certain circumstances, we may share information for purposes of research.

Sensitive Information

Certain types of especially sensitive health information, such as HIV-related, mental health and substance abuse treatment records, are subject to heightened protection under the law. If any state or federal law or regulation governing this type of sensitive information restricts us from using or sharing your information in any manner otherwise permitted under this Notice, we will follow the more restrictive law or regulation.

Your Authorization

If one of the preceding reasons does not apply, we must obtain your written authorization to use or disclose your health information.

If you give us written authorization and change your mind, you may revoke your written authorization at any time, except to the extent we have already acted in reliance on your authorization. Once you give us authorization to release your health information, we cannot guarantee that the person to whom the information is provided will not re-disclose the information.

Our authorization form will describe the purpose for which the information is to be used, the time period during which the authorization form will be in effect, and your right to revoke authorization at any time. The authorization form must be completed and signed by you or your duly authorized representative and returned to us before we will disclose any of your protected health information. You may obtain a copy of this form by calling 877-305-1941 TTY-711

Your Rights

The following are your rights with respect to the privacy of your health information. If you would like to exercise any of the following rights, please contact us by calling 877-305-1941 TTY-711

Restricting Your Information

You have the right to ask us to restrict how we use or disclose your information for treatment, payment or health care operations. You also have the right to ask us to restrict information that we have been asked to give to family members or to others who are involved in your health care or payment for your health care. Please note that while we will try to honor your request, we are not required to agree to these restrictions.

Confidential Communications for Your Information

You have the right to ask to receive confidential communications of information if you believe that you would be endangered if we sent your information to your current mailing address (for example, in situations involving domestic disputes or violence).

If you are a minor and have received health care services based on your own consent or in certain other circumstances, you also may have the right to request to receive confidential communications in certain circumstances, if permitted by state law. You may ask us to send the information to an alternative address or by alternative means, such as by fax. We may require that your request be in writing and you specify the alternative means or location, as well as the reason for your request. We will accommodate reasonable requests. Please be aware that the explanation of benefits statement(s) that your health plan issues to the contract holder or certificate holder may contain sufficient information to reveal that you obtained health care for which the Plan paid, even though you have asked that we communicate with you about your health care in confidence.

Inspecting Your Information

You have the right to inspect and obtain a copy of information that we maintain about you in your designated record set.

A “designated record set” is the group of records used by or for us to make benefit decisions about you. This can include enrollment, payment, claims and case or medical management records. We may require that your request be in writing. We may charge a fee for copying information or preparing a summary or explanation of the information and in certain situations, we may deny your request to inspect or obtain a copy of your information.

Amending Your Information

You have the right to ask us to amend information we maintain about you in your designated record set. We may require that your request be in writing and that you provide a reason for your request. We may deny your request for an amendment if we did not create the information that you want amended and the originator remains available or for certain other reasons. If we deny your request, you may file a written statement of disagreement.

Accounting of Disclosures of Your Information to Others

You have the right to receive an accounting of certain disclosures of your information made by us for purposes other than treatment, payment or health care operations during the six years prior to your request. We may require that your request be in writing.

If you request such an accounting more than once in a 12-month period, we may charge a reasonable fee.

Please note that we are not required to provide an accounting of the following:

- Any information collected prior to April 14, 2003.

- Information disclosed or used for treatment, payment and health care operations purposes.

- Information disclosed to you or following your authorization.

- Information that is incidental to a use or disclosure otherwise permitted.

- Information disclosed to persons involved in your care or other notification purposes.

- Information disclosed for national security or intelligence purposes.

- Information disclosed to correctional institutions or law enforcement officials.

- Information that was disclosed or used as part of a limited data set for research, public health or health care operations purposes.

Collecting, Sharing and Safeguarding Your Financial Information

In addition to health information, we may collect and share other types of information about you with your health plan/carrier. We may collect and share the following types of personal information:

• Name, address, telephone number and/or email address;

• Names, addresses, telephone numbers and/or email addresses of your spouse and dependents;

• Your social security number, age, gender and marital status;

• Social security numbers, age, gender and marital status of your spouse and dependents;

• Any information that we receive about you and your family when we administer your claim or authorizations;

We may share this information with our affiliates and with your health plan and/or business associates that perform services on our behalf. For example, we may share such information with vendors that conduct medical review and other services on our behalf. These business associates must maintain the confidentiality of the information. We may also share such information when necessary to process transactions at your request and for certain other purposes permitted by law.

To the extent that such information may be or become part of your medical records, claims history or other health information, the information will be treated like health information as described in this notice.

As with health information, we use security safeguards and techniques designed to protect your personal information that we collect, use or disclose in writing, orally and electronically. We train our employees about our privacy policies and practices, and we limit access to your information to only those employees who need it in order to perform their business responsibilities. We do not sell information about our customers or former customers.

Exercising Your Rights, Complaints and Questions

You have the right to receive a paper copy of this notice upon request at any time. You can also view a copy of this notice on the New Century Health web site. See information at the end of this page. We must abide by the terms of this notice.

If you have any questions or would like further information about this notice or about how we use or share information, you may write to our Compliance Department or call Customer Service . Please see the contact information on this page.

If you believe that we may have violated your privacy rights, you may file a complaint by contacting the Compliance Department at the address or phone number listed below.

We will take no action against you for filing a complaint.

You may call the Compliance Department at the number listed on this page. You may also file a complaint by mail to the Compliance Department at the mailing address on this page. You may also notify the Secretary of the U.S. Department of Health and Human Services.

If we become aware that we or one of our business associates has experienced a breach of your personal information, as defined by federal and state laws, we will take action in accordance with applicable laws and regulations. This may include notifying you and certain governmental, regulatory and media agencies about the breach.

Contact Information

Write to:
New Century Health
Compliance Dept.
675 Placentia Ave., Suite 300
Brea, CA 92821

Call:
877-305-1941 TTY-711

Personal Information After You Are No Longer Enrolled

Even after you are no longer enrolled in any plan, we may maintain your personal information as required by law or as necessary to carry out plan administration activities on your behalf. Our policies and procedures that safeguard that information against inappropriate use and disclosure still apply if you are no longer enrolled in the Plan.

Changes to this Notice

We are required to abide by the terms of this Notice of Privacy Practices as currently in effect. We reserve the right to change the terms of the notice and to make the new notice effective for all the protected health information that we maintain. Prior to implementing any material changes to our privacy practices, we will promptly revise our notice and provide a copy on our website. www.newcenturyhealth.com

* Revision Date: June 10, 2011