Effective date. The effective date of this Notice is September 23, 2013.This Notice is required by law. The Steamfitters Industry Welfare Fund (the “Fund”) is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information and to inform you about:

1. The Fund’s uses and disclosures of Protected Health Information (PHI),
2. Your rights to privacy with respect to your PHI,
3. The Fund’s duties with respect to your PHI,
4. Your right to file a complaint with the Fund and with the Secretary of the U.S .Department of Health and Human Services, and
5. The person or office you should contact for further information about the Fund’s privacy practices.

Protected Health Information (PHI) Defined 

The term “Protected Health Information” (PHI) includes all information  related to your past or present health condition that individually identifies you or could reasonably be used to identify you and is transferred to another entity or maintained by the Fund in oral, written, electronic or any other form.

The Plan Sponsor has amended its Plan Documents to protect your PHI as required by federal law. Under the law, the Fund may disclose your PHI without your consent in the following cases:

1. At your request. If you request it, the Fund is required to give you access to certain PHI in order to inspect it and copy it.
2. As required by an agency of the government. The Secretary of the Department of Health and Human Services may require the disclosure of your PHI to investigate or determine the Fund’s compliance with the privacy regulations.
3. For treatment, payment or health care operations. The Fund and its business associates will use PHI without your consent, authorization or opportunity to agree or object in order to carry out:
   1. Treatment,
   2. Payment, or
   3. Health care operations.

Treatment is the provision, coordination, or management of health care and related services.  It also includes but is not limited to consultations and referrals between one or more of your providers. 

For example:The Fund may disclose to a treating orthodontist the name of your treating dentist so that the orthodontist may ask for your dental x-rays from the treating dentist. 

Payment includes but is not limited to actions to make coverage determinations and payment (including billing, claims management, subrogation, Fund reimbursement, reviews for medical necessity and appropriateness of care and utilization review and pre-authorizations).

For example: The Fund may tell a doctor whether you are eligible for coverage or what percentage of the bill will be paid by the Fund.  If we contract with third parties to help us with payment operations, such as a physician that reviews medical claims, we will also disclose information to them.  These third parties are known as “business associates.”  We will also disclose enrollment information to contributing employers.    

Health care operations includes but is not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, underwriting, premium rating and other insurance activities relating to creating or renewing insurance contracts.  It also includes disease management, case management, conducting or arranging for medical review, legal services, and auditing functions including fraud and abuse compliance programs, business planning and development, business management and general administrative activities.

For example:The Fund may use information about your claims to refer into a disease management program, a well-pregnancy program, project future benefit costs or audit the accuracy of its claims processing functions.

Disclosure to the Fund’s Trustees.   The Fund will also disclose PHI to the Fund Sponsor, the Board of Trustees of the Steamfitters’ Industry Welfare Fund, for purposes related to treatment, payment, and health care operations, and has amended the Fund Documents to permit this use and disclosure as required by federal law.  

For example, we may disclose information to the Board of Trustees to allow them to decide an appeal or review a subrogation claim.

The Fund must generally obtain your written authorization before (each of these include defined exceptions under which the Fund use or disclose your PHI for these purposes without your authorization):

1. Using or disclosing psychotherapy notes about you from your psychotherapist.

Psychotherapy notes are separately filed notes about your conversations with your mental health professional during a counseling session.  They do not include summary information about your mental health treatment.  The Fund is not likely to have access to or maintain these types of notes.

1. Using or disclosing your PHI for marketing purposes (a communication that encourages you to purchase or use a product or service) if the Fund receives direct or indirect financial remuneration (payment) from the entity whose product or service is being marketed. 
2. Receiving direct or indirect remuneration (payment or other benefit) in exchange for receipt of your PHI.  

Disclosure of your PHI to family members, other relatives and your close personal friends without your written consent or authorization is allowed if:

1. The information is directly relevant to the family or friend’s involvement with your care or payment for that care, and
2. You have either agreed to the disclosure or have been given an opportunity to object and have not objected.

The Fund is allowed to use and disclose your PHI without your consent, authorization or request under the following circumstances:

1. When required by law.
2. Public health purposes. When permitted for purposes of public health activities. This includes reporting product defects, permitting product recalls and conducting post-marketing surveillance. PHI may also be used or disclosed if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if authorized by law.
3. Domestic violence or abuse situations. When authorized by law to report information about abuse, neglect or domestic violence to public authorities if a reasonable belief exists that you may be a victim of abuse, neglect or domestic violence. In such case, the Plan will promptly inform you that such a disclosure has been or will be made unless that notice would cause a risk of serious harm. For the purpose of reporting child abuse or neglect, it is not necessary to inform the minor that such a disclosure has been or will be made. Disclosure may generally be made to the minor’s parents or other representatives, although there may be circumstances under federal or state law when the parents or other representatives may not be given access to the minor’s PHI.
4. Oversight activities. To a public health oversight agency for oversight activities authorized by law. These activities include civil, administrative or criminal investigations, inspections, licensure or disciplinary actions (for example, to investigate complaints against providers) and other activities necessary for appropriate oversight of government benefit programs (for example, to investigate Medicare or Medicaid fraud).
5. Court proceedings. When required for judicial or administrative proceedings. For example, your PHI may be disclosed in response to a subpoena or discovery request, provided certain conditions are met, including that:
   1. the requesting party must give the Fund satisfactory assurances a good faith attempt has been made to provide you with written notice, and 
   2. the notice provided sufficient information about the proceeding to permit you to raise an objection, and 
   3. No objections were raised or were resolved in favor of disclosure by the court or tribunal.
6. Law enforcement health purposes. When required for law enforcement purposes (for example, to report certain types of wounds).
7. Law enforcement emergency purposes. For law enforcement purposes if the law enforcement official represents that the information is not intended to be used against the individual, the immediate law enforcement activity would be materially and adversely affected by waiting to obtain the individual’s agreement and the Plan in its best judgment determines that disclosure is in the best interest of the individual. Law enforcement purposes include:
   1. identifying or locating a suspect, fugitive, material witness or missing person, and
   2. disclosing information about an individual who is or is suspected to be a victim of a crime, but only if the individual agrees to the disclosure or the covered entity is unable to obtain the individual’s agreement because of emergency circumstances.
8. Determining cause of death. When required to be given to a coroner or medical examiner to identify a deceased person, determine a cause of death or other authorized duties. 
9. Funeral purposes. When required to be given to funeral directors to carry out their duties with respect to the decedent.
10. Research. For research, subject to certain conditions.
11. Health or safety threats. When, consistent with applicable law and standards of ethical conduct, the Plan in good faith believes the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to a person reasonably able to prevent or lessen the threat, including the target of the threat.
12. Workers compensation programs. When authorized by and to the extent necessary to comply with workers’ compensation or other similar programs established by law.

Any other Fund  uses and disclosures not described in Section 2 of this Notice will be made only if you provide the Fund with written authorization, subject to your right to revoke your authorization.

If a breach of your unsecured PHI occurs, the Fund will notify you.

You may request the Fund to:

1. Restrict the uses and disclosures of your PHI to carry out treatment, payment or health care operations, or 
2. Restrict uses and disclosures to family members, relatives, friends or other persons identified by you who are involved in your care. 

The Plan, however, is not required to agree to your request.

The Plan will accommodate reasonable requests to receive communications of PHI by alternative means or at alternative locations. 

You or your personal representative will be required to complete a form to request restrictions on uses and disclosures of your PHI. Make such requests to:

Mr. James C. White Policy Official

Steamfitters’ Industry Welfare Fund

27-08 40th Ave, 2nd Fl

Long Island City, NY 11101-3725

You May Inspect and Copy PHI

You have a right to inspect and obtain a copy of your PHI (in hardcopy or electronic form) contained in a “designated record set,” for as long as the Fund maintains the PHI. You may request your hardcopy or electronic information in a format that is convenient for you, and the Fund will honor that request to the extent possible. You also may request a summary of your PHI.

Designated Record Set: Includes your medical records and billing records that are maintained by or for a covered health care provider.  Records include enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for a health plan or other information used in whole or in part by or for the covered entity to make decisions about you.  Information used for quality control or peer review analyses and not used to make decisions about you is not included.

The Fund must provide the requested information within 30 days. A single 30-day extension is allowed if the Fund is unable to comply with the deadline and if the Plan provides you with a notice of the reason for the delay and the expected date by which the requested information will be provided.

You or your personal representative will be required to complete a form to request access to the PHI in your designated record set. You may be charged a reasonable, cost-based fee for creating or copying the PHI, or preparing a summary of your PHI. Requests for access to PHI should be made to the following officer:

Mr. James C. White Policy Official

Steamfitters Industry Welfare Fund

27-08 40th Ave, 2nd Fl

Long Island City, NY 11101-3725

If access is denied, you or your personal representative will be provided with a written denial setting forth the basis for the denial, a description of how you may exercise those review rights and a description of how you may complain to the Secretary of the U.S. Department of Health and Human Services.

You have the right to request that the Fund amend your PHI or a record about you in a designated record set for as long as the PHI is maintained in the designated record set.

The Fund has 60 days after receiving your request to act on it. The Fund is allowed a single 30-day extension if the Fund  is unable to comply with the 60-day deadline. If the Fund denied your request in whole or part, the Fund must provide you with a written denial that explains the basis for the decision. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of your PHI.

You should make your request to amend PHI to the following officer:

Mr. James C. White Policy Official

Steamfitters Industry Welfare Fund

27-08 40th Ave, 2nd Fl

Long Island City, NY 11101-3725

You or your personal representative will be required to complete a form to request amendment of the PHI.

At your request, the Fund  will also provide you with an accounting of disclosures by the Fund of your PHI during the six years before the date of your request. However, such accounting need not include PHI disclosures made:

1. To carry out treatment, payment or health care operations,
2. To you about your own PHI, or
3. Before the privacy rule compliance date.

The Fund has 60 days to provide the accounting. The Fundis allowed an additional 30 days if theFund gives you a written statement of the reasons for the delay and the date by which the accounting will be provided.

If you request more than one accounting within a 12-month period, the Fund will charge a reasonable, cost-based fee for each subsequent accounting.

To obtain a paper copy of this Notice, contact the following officer:

Mr. James C. White Policy Official

Steamfitters Industry Welfare Fund

27-08 40th Ave, 2nd Fl

Long Island City, NY 11101-3725

This right applies even if you have agreed to receive the Notice electronically.

Your Personal Representative

You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of authority to act on your behalf before the personal representative will be given access to your PHI or be allowed to take any action for you. Proof of such authority may take one of the following forms:

1. A power of attorney for health care purposes, notarized by a notary public,
2. A court order of appointment of the person as the conservator or guardian of the individual,
3. An Appointment of Personal Representative form that is completed and signed by you, or
4. The status of the personal representative as the parent of a minor child.

The Fund retains discretion to deny access to your PHI to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect. This also applies to personal representatives of minors.

The Fund is required by law to maintain the privacy of your PHI and to provide you and your eligible dependents with notice of its legal duties and privacy practices. In addition, the Fund may not (and does not) use your genetic information that is PHI for underwriting purposes. This notice is effective beginning on September 23, 2013 and the Fund is required to comply with the terms of this notice. However, the Fund reserves the right to change its privacy practices and to apply the changes to any PHI received or maintained by the Fund prior to that date. If a privacy practice is changed, a revised version of this notice will be provided to you and to all past and present participants and beneficiaries for whom the Fund still maintains PHI. 

If material changes are made to this Notice, it will be posted to the Fund’s website no later than September 23, 2013 and thereafter sent in the Fund’s next annual mailing.

Material changes are changes to: 

1. The uses or disclosures of PHI, 
2. Your individual rights, 
3. The duties of the Plan, or 
4. Other privacy practices stated in this notice

When using or disclosing PHI or when requesting PHI from another covered entity, the Fund  will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations.

However, the minimum necessary standard will not apply in the following situations:

1. Disclosures to or requests by a health care provider for treatment,
2. Uses or disclosures made to you, 
3. Disclosures made to the Secretary of the U.S. Department of Health and Human Services, 
4. Uses of disclosures required by law, and
5. Uses of disclosures required for the Plan’s compliance with legal regulations.

This notice does not apply to information that has been de-identified. De-identified information is information that: 

1. Does not identify you, and 
2. With respect to which there is no reasonable basis to believe that the information can be used to identify you.

The “Fund Sponsor” of the Fund is the Steamfitters Industry Welfare Fund Board of Trustees. As described in the amended Plan document, the Fund may share PHI with the Fund Sponsor (Board of Trustees) for limited administrative purposes, such as determining claims and appeals, performing quality assurance functions and auditing and monitoring the Fund. The Fund  shares the minimum information necessary to accomplish these purposes.

In addition, theFund may use or disclose “summary health information” to the Fund Sponsor for obtaining premium bids or modifying, amending or terminating the group health Fund. Summary information summarizes the claims history, claims expenses or type of claims experienced by individuals for whom a Fund Sponsor has provided health benefits under a group health plan. Identifying information will be deleted from summary health information, in accordance with HIPAA.

If you believe that your privacy rights have been violated, you may file a complaint with theFund in care of the following officer:

Mr. James C. White Policy Official

Steamfitters Industry Welfare Plan

27-08 40th Ave, 2nd Fl

Long Island City, NY 11101-3725

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. Filing instructions are available at: 

http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html

The Fund will not retaliate against you for filing a complaint.

If you have any questions regarding this notice or the subjects addressed in it, you may contact the following officer at the Fund Office:

 

Mr. James C. White Policy Official

Steamfitters’ Industry Welfare Fund

27-08 40th Ave, 2nd Fl

Long Island City, NY 11101-3725

PHI use and disclosure by the Fund  is regulated by the federal Health Insurance Portability and Accountability Act, known as HIPAA. You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. This notice attempts to summarize the regulations. The regulations will supersede this notice if there is any discrepancy between the information in this notice and the regulations.