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.
Protecting the privacy of information about your medical conditions and health is a responsibility we take very seriously. We understand that medical information about you and your health is personal, and it is important to you that we keep it confidential. We are committed to the practices and procedures we established to protect the confidential nature of information about your health.
This notice describes the ways in which we may use and disclose information about your health to carry out treatment, payment and health care operations, and for other purposes as permitted or required by law. It also describes your rights and our duties regarding the use and disclosure of health information.
Uses & disclosures of information about your health without your authorization
The following categories describe different ways that we may use and disclose information about your health without your written authorization. For each category, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information without written authorization fall within one of these categories:
- Treatment—We do not use information about your health to provide you with medical treatment or related services.
- Payment—Generally, we use and disclose information about your health so we can administer claims, which includes reimbursing incurred expenses for treatment and services you receive from a health care provider. For example, we may disclose this information to your health care provider to verify insurance coverage for medical treatment or service expenses.
- Health care operations—We use and disclose information about your health for our insurance operations. These uses and disclosures are necessary for our business and to make sure our members are receiving quality service. Some examples of how we may use and disclose information about your health include underwriting insurance, processing transactions, resolving grievances and conducting business planning.
We may also disclose information about your health to our business associates to enable them to perform services for us or on our behalf relating to our operations. At the time you apply for insurance, we may disclose information about your health in encoded form to the Medical Information Bureau (MIB) in an effort to deter fraud, misrepresentation or criminal activity.
- Public health risks—As required by law, we may disclose information about your health to public health authorities that receive information to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; notify a person who may be at risk for contracting or spreading a disease or condition.
- Health oversight activities—We may disclose information about your health to a health oversight agency for activities authorized by law. Examples of these oversight activities include audits, investigations and inspections. These activities are necessary for the government to monitor the health care system, government programs and entities subject to civil rights laws.
- Lawsuits & disputes—If you are involved in a lawsuit or a dispute, we may disclose information about your health in response to a court or administrative order. We may also disclose this information in response to a subpoena, discovery request, or other lawful processes by someone else involved in the dispute. We will make reasonable efforts to tell you about the request.
- Law enforcement—We may release information about your health if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process; and about a death that may be the result of criminal conduct. We may also release information about your health to law enforcement or other governmental authorities to protect us against the perpetration of fraud or other illegal activities.
- Coroners, medical examiners and funeral directors—We may release information about your health to a coroner or medical examiner. We also may release information about your health to funeral directors as necessary to carry out their duties.
- Research—Under certain circumstances, we may use information about your health for insurance research purposes. We may also disclose information about your health to organizations conducting actuarial or insurance research studies.
- To avert a serious threat to health or safety—Although it is not our practice, we may use and disclose information about your health when necessary to help prevent a serious threat to the health and safety of you or others. Any disclosure, however, would only be to someone able to help prevent the threat.
- Military and Veterans—If you are a member of the armed forces, we may release information about your health as required by military command authorities.
- Workers' compensation—We may release information about your health to comply with laws relating to workers' compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Uses & disclosure of information about your health with your authorization
The following use and disclosures will only be made with authorization from you:
- Use and disclosures of health information for marketing purposes;
- Use and disclosures of psychotherapy notes, unless permitted by law;
- Disclosures that constitute the sale of personal health information.
Other uses and disclosures of information about your health that are not described in this notice or are not otherwise permitted by law will be made only with your written authorization. You may revoke such authorization as described in this notice.
Your rights regarding information about your health
You have the following rights regarding the health information we maintain about you, which you may exercise by submitting your request in writing to:
Attention: Privacy Office
4321 N. Ballard Rd.
Appleton, Wisconsin 54919-0001
- Right to revoke authorization—You may revoke your authorization that allows us to use or disclose health information that is not otherwise covered by this notice or applicable law in writing at any time except when the authorization was obtained as a condition of obtaining insurance; during the contestable period; or to the extent that we have taken action in reliance on your written authorization. You understand we are unable to take back any disclosures we have already made with your authorization and that we may retain documents that may contain information about your health.
Right to request restrictions—You have a right to request a restriction on the information about your health that we use or disclose for treatment, payment or health care operations. You also have the right to request a limit on the information we disclose about your health to someone who is involved in your care or the payment for your care, such as a family member.
In your request, you must tell us: the information you want to limit; whether you want to limit our use, disclosure or both; and to whom you want the limits to apply (for example, disclosures to your spouse).
We are not required to agree to your requested restriction or limitation unless the protected health information pertains solely to healthcare for which you, not a health plan, have paid us or your provider in full.
- Right to request confidential communications—If you could be endangered by our normal communication channels, you have the right to request that we communicate information about your health to you by alternative means or at an alternative location. We will ask you the reason for your request, and we will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to inspect and copy—You have a right to inspect and copy information about your health that we maintain. Usually, this includes medical and billing records. Under Federal law, this right does not include psychotherapy notes or information about your health compiled in reasonable anticipation of litigation, administrative action or administrative proceeding. If you request a copy of this information, we may charge a standard fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain limited circumstances, such as where disclosure would reasonably endanger the life or physical safety of you or another person. If you are denied access to information about your health, you may request that the denial be reviewed.
Right to amend—If you believe the information we have about your health is incorrect or incomplete, you may ask us to amend the information. You must provide a reason that supports your request. You have the right to request an amendment for as long as the information is kept by or for us.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the information about your health kept by or for us;
- Is not part of the information about your health that you would be permitted to inspect and copy;
- Is accurate and complete.
- Right to request an accounting—You have the right to receive an accounting of certain disclosures of information about your health that we made if any. This right applies to disclosures for purposes other than treatment, payment, health care operations or as otherwise permitted or required by law. You have a right to receive specific information about these disclosures that occur after Nov. 1, 2002. The right to receive this information is subject to certain exceptions, restrictions and limitations.
- Right to a copy of this notice—You have the right to obtain a copy of this notice at any time.
Our duties regarding information about your health
We are required by law to:
- Maintain the privacy of information about your health;
- Notify you following a breach of your unsecured protected health information;
- Provide you with this notice of our legal duties and health information privacy practices;
- Not use or disclose protected health information that is genetic information to underwrite for Medicare supplement Insurance; and
- Abide by the terms of this notice.
Changes to this notice
We reserve our right to change the terms of this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. If we make a material change to the terms of this notice, we will mail a revised notice to you.
For more information or to file a complaint
If you have questions and would like additional information, you may contact us at
If you believe your privacy rights have been violated, you may file a written complaint with our privacy office and with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint.