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CITY OF IOWA CITY
PRIVACY PRACTICES NOTICE
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. THE PRIVACY OF YOUR MEDICAL
INFORMATION IS IMPORTANT TO US.
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your medical information. We are also required to give you this
notice about our privacy practices, our legal duties, and your rights concerning your medical information. We must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect October 3, 2022, and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our
privacy practices and the new terms of our notice
effective for all medical information that we maintain, including medical information we created
or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and send the new notice available to our health plan subscribers at the time of
the change.
You may request a copy of our notice at any
time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.
City of Iowa City Health Plans Covered by this Notice
Medical Insurance Plan IRS Section 125 Flexible Spending Medical Account Dental Insurance Plan Employee Assistance Program Vision Insurance Plan
Uses and Disclosures of Medical Information
We use and disclose medical information about you for treatment, payment, and health care operations. For example:
Treatment: We may use or disclose your medical information to a physician or other health care provider in order to provide treatment to you.
Payment: We may use and disclose your medical information to pay claims from physicians, hospitals and other providers for services delivered to you that are covered by your health plan, to determine your eligibility for benefits, to coordinate benefits, to examine medical necessity, to obtain premiums, to issue explanations of benefits to the person who subscribes to the health plan in which
you participate, and the like. We may disclose your medical information to a health care provider or entity subject to the federal Privacy Rules so they can obtain payment or engage in these payment activities.
Health Care Operations: We may use and disclose your medical information in connection with our health care operations. Health care operations include:
• rating our risk and determining our premiums for
your health plan;
• quality assessment and improvement activities;
• reviewing the competence or qualifications of
health care professionals, evaluating practitioner and provider performance, conducting training
programs, accreditation, certification, licensing or credentialing activities;
• medical review, legal services, and auditing, including fraud and abuse detection and compliance;
• business planning and development; and
• business management and general administrative activities, including management activities relating to privacy, customer service, resolution of internal grievances, and creating de-identified
medical information or a limited data set.
We may disclose your medical information to another entity which has a relationship with you and is subject to the federal Privacy Rules, for their health
care operations relating to quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, or detecting or preventing health care fraud and abuse.
On Your Authorization: You may give us written authorization to use your medical information
or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. To the extent that we maintain or receive psychotherapy notes about you, most
disclosures of these notes require your authorization. In addition, most uses and disclosures of medical information for marketing purposes, and disclosures that constitute a sale of protected health information, require your authorization. Unless you give us a written authorization, we will not use or disclose your medical information for any reason except those described in this notice.
To Your Family and Friends: We may disclose your medical information to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care. We may use or disclose your name, location, and general condition or death to notify, or assist in the notification of (including identifying or locating), a person involved in your care.
Before we disclose your medical information to a person involved in your health care or payment for your health care, we will provide you with an opportunity to object to such uses or disclosures. If you are not present, or in the event of your incapacity or an emergency, we will disclose your medical information based on our professional judgment of whether the disclosure would be in your best interest.
Your Employer or Organization Sponsoring Your Group Health Plan: We may disclose your medical information and the medical information of others enrolled in your group health plan to the
employer or other organization that sponsors your group health plan to permit the plan sponsor to perform plan administration functions. Please see your group health plan document for a full explanation of the limited uses and disclosures that the plan sponsor may make of your medical
information in providing plan administration.
We may also disclose summary information about the enrollees in your group health plan to the plan sponsor to use to obtain premium bids for the health insurance coverage offered through your group health plan or to decide whether to modify, amend or
terminate your group health plan. The summary information we may disclose summarizes claims history, claims expenses, or types of claims experienced by the enrollees in your group health plan. The summary information will be stripped of demographic information about the enrollees in the group health plan, but the plan sponsor may still be able to identify you or other enrollees in your group health plan from the summary information.
Underwriting: We may receive your medical
information for underwriting, premium rating or other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits. We are prohibited from using or disclosing your genetic information for underwriting purposes. We will not use or further disclose this medical information for any other purpose, except as required by law, unless the contract of health insurance or health benefits is placed with us. In that case, our use and disclosure of your medical information will only be as described in this notice.
Disaster Relief: We may use or disclose your medical information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.
Public Benefit: We may use or disclose your medical information as authorized by law for the following purposes deemed to be in the public interest or benefit:
• as required by law;
• for public health activities, including disease and vital statistic reporting, child abuse reporting, FDA oversight, and to employers regarding work-related illness or injury;
• to report adult abuse, neglect, or domestic violence;
• to health oversight agencies;
• in response to court and administrative orders and other lawful processes;
• to law enforcement officials pursuant to
subpoenas and other lawful processes, concerning crime victims, suspicious deaths, crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person;
• to coroners, medical examiners, and funeral directors;
• to organ procurement organizations;
• to avert a serious threat to health or safety;
• in connection with certain research activities;
• to the military and to federal officials for lawful
intelligence, counterintelligence, and national security activities;
• to correctional institutions regarding inmates; and
• as authorized by state worker’s compensation laws.
Individual Rights
Access: You have the right to look at or get copies of your medical information, with limited exceptions. You may request that we provide copies in a format other than photocopies. This may include an electronic copy in certain circumstances. We will use the format you request unless we cannot practicably do so. Information requests not included under treatment, payment or healthcare operations or otherwise allowed by the regulations may require written authorization from the individual. You may obtain a form to request access by using the contact information listed at the end of this notice. You may also request access by sending a letter to the address at the end of this notice. If you request copies, we will charge you a cost-based fee for staff time to locate and copy your medical information, plus postage if you want the copies mailed to you. If you request an alternative format, we will charge a cost-based fee for providing your medical information in that format. If you prefer, we will prepare a summary or an explanation of your medical information for a fee. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
Disclosure Accounting: You have the right to receive a list of instances in which we or our business associates disclosed your medical information for purposes other than treatment, payment, health care operations, as authorized by you, and for certain other activities. You are entitled to such an accounting for the 6 years prior to your request, though not earlier than April 14, 2004. We will provide you with the date on which we made the disclosure, the name of the person or entity to whom we disclosed your medical information, a description of the medical information we disclosed, the reason for the disclosure, and certain other information. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-
based fee for responding to these additional requests. Contact us using the information listed at the end of this notice for a full explanation of our fee structure.
Restriction: You have the right to request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency). Any agreement to additional restrictions must be in writing signed by a person authorized to make such an agreement on our behalf. We will not be bound unless our agreement is so memorialized in writing.
Confidential Communication: You have the right to request that we communicate with you about your medical information by alternative means or to alternative locations. You must make your request writing, and you must state that the information could endanger you if it is not communicated in confidence as you request. We must accommodate your request if it is reasonable, specifies the alternative means or location, and continues to permit us to collect premiums and pay claims under your health plan, including issuance of explanations of benefits to the
subscriber of the health plan in which you participate. An explanation of benefits issued to the subscriber for health care that you received for which you did not request confidential communications or about the subscriber or others covered by the health plan in which you participate may contain sufficient information to reveal that you obtained healthcare for which we paid, even though you requested that we communicate with you about that health care in confidence.
Amendment. You have the right to request that we amend your medical information. Your request must be in writing, and it must explain why the
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information should be amended. We may deny your request if we did not create the information you want amended and the originator remains available or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be
appended to the information you wanted amended. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.
Electronic Notice: If you receive this notice on our web site or by electronic mail (e-mail), you are entitled to receive this notice in written form. Please contact us using the information listed at the end of
this notice to obtain this notice in written form.
Breach Notification: In the event of a breach of
your unsecured health information, we will provide you notification of such a breach, as required by law.
Questions and Complaints
If you want more information about our privacy
practices or have questions or concerns, please contact us using the information listed at the end of
this notice.
If you are concerned that we may have violated
your privacy rights, or you disagree with a decision we made about access to your medical information or
in response to a request you made to amend or restrict the use or disclosure of your medical
information or to have us communicate with you by alternative means or at alternative locations, you may
complain to us using the contact information listed at
the end of this notice. You also may submit a written complaint to the U.S. Department of Health and
Human Services. We will provide you with the address to file your complaint with the U.S.
Department of Health and Human Services upon request.
We support your right to the privacy of your medical information. We will not retaliate in any
way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Contact Office: Human Resources Administrator City of Iowa City 410 E. Washington Street Iowa City, IA 52240 Phone: 319-356-5025 Fax: 319-356-5027 Email: jobs@iowa-city.org