Notice of Privacy Practices
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.
City of Freeport administers part or all of your health flexible spending account. Federal law requires City of Freeport to protect the privacy of your health information when administering your health flexible spending account. Also, federal law requires City of Freeport to give you a copy of this notice that explains City of Freeport's responsibilities and your rights under the federal privacy rule.
This Notice of Privacy Practices is effective April 14, 2004.
If you have questions or want additional information about City of Freeport's privacy practices, please contact: Lei Loni Kershaw
City of Freeport
200 W 2nd St.
Freeport, TX 77541
(979) 233-3526 ext. 108
What information is protected by the privacy rule?
The privacy rule protects information that identifies you if it comes from the health flexible spending account and is:
- about your enrollment in the health flexible spending account;
- about your health; or
- about your health care, treatment and services.
- a Family and Medical Leave Act (FMLA) request;
- an Americans with Disabilities (ADA) accommodation request;
- a workers compensation claim.
Can City of Freeport give my protected health information to others?
Yes. City of Freeport can share your protected health information with other people or organizations. City of Freeport will share your protected health information only when necessary for payment or health care operations, when required or allowed by law or when authorized by you.
Payment and Health Care Operations
City of Freeport is allowed to share information needed to collect payment from you or to make a payment decision on a claim. For example, City of Freeport or its claim administrator may share information with another health plan to decide if an expense is payable from your health flexible spending account.
In addition to payment, City of Freeport is allowed to share your protected health information for health care operations. Health care operations are the business functions that City of Freeport performs to administer the health flexible spending account. They include things like quality assessment and improvement, activities necessary to renew the health flexible spending account, legal services, auditing functions including fraud and abuse compliance programs, business planning and development, business management and general administrative activities. For example, City of Freeport must share your enrollment information with our claims administrator so they can pay your claims.
When Required or Permitted by Law
City of Freeport may share your protected health information, as described below, when it is required or allowed by law.
- With you or your personal representative. (A personal representative is a person who has the legal right to make health care decisions for you.)
- With the Secretary of the U.S. Department of Health and Human Services to investigate or determine City of Freeport's compliance with the privacy rule.
- For public health activities.
- With public agencies that audit, investigate and inspect health programs.
- For legal proceedings, such as a court case.
- To police, FBI officers and others who enforce laws.
- To stop a serious threat to health or safety.
- For special government functions, when required by law.
- Whenever else required by law.
When Authorized by You
City of Freeport cannot share your protected health information for any reason not included in this notice unless you give your permission in writing. Your written permission is called an authorization. To be legal, an authorization must include all of the following:
- The name of the person or organization who may release or give out your protected health information. (This is usually a health plan or a health care provider.)
- The name of the person or organization who may receive your protected health information.
- A description of the information that may be shared.
- The reason the information is being shared.
- An end date or an end event for the authorization.
- Your signature and the date signed. (If the authorization is signed by your personal representative, it must include an explanation of his or her right to sign for you.)
What rights do I have under the privacy rule?
The privacy rule gives you the right to:
- ask for limits on the sharing of your health information;
- ask for confidential communications;
- access your health information;
- ask City of Freeport to correct your health records; and
- get a list of who City of Freeport shared your protected health information with.
You have the right to ask City of Freeport not to share your protected health information with certain people or organizations or for certain reasons. However, City of Freeport does not have to agree to your request. A request to limit the sharing of health information must be made in writing.
You have the right to ask that communications about your health flexible spending account be made by alternate means or to alternate locations. For example, you may request that explanations of benefits be sent to your work address instead of your home address. City of Freeport does not have to agree to your request unless you state that not complying with your request could place you in danger. Requests for confidential communications must be reasonable, must be in writing and must specify an alternate means or location for the delivery of communications.
Access to Your Health Information
You have the right to see any records used to make benefit decisions under your health flexible spending account. Your request to see your records must be made in writing. You also may make a written request for a paper copy of your records. If you request paper copies, City of Freeport, or another person or organization making the copies, may charge you a reasonable, cost-based fee for the copies.
Correction of Health Records
If you find a mistake in your records that are used to make benefit decisions, you have the right to ask that your records be corrected. A request for correction must be in writing and must be mailed to the person or organization who made the mistake.
List of Who Received My Health Information
You may ask City of Freeport for a list of who received your protected health information. Your request must be made in writing. The list will not include information:
- shared for City of Freeport payment or health care operations;
- shared with you;
- shared based on your written authorization;
- reported on a previous list; or
- shared more than six years before the date your request is received. However, City of Freeport doesn't have to tell you about any protected health information shared before April 14, 2004.
Can City of Freeport change its privacy practices?
City of Freeport is required, by law, to follow the terms of this notice for as long as it is in effect. City of Freeport reserves the right to change our privacy practices and to apply the changes to any protected health information we received or maintained before the effective date of the change. If City of Freeport changes our privacy practices, we must revise this notice and provide you a copy of the new notice before the change takes effect.
How can I get a copy of the current notice?
You can print a copy of City of Freeport's Notice of Privacy Practices off our website at www. freeport.tx.us. Also, you may request a paper copy of the notice by calling Lei Loni Kershaw at (979) 233-3526 ext. 108.
Who do I contact if I believe my privacy rights have been violated?
If you believe your privacy rights have been violated, contact:
Lei Loni Kershaw
City of Freeport
200 W. 2nd St.
Freeport, TX 77541
(979) 233-3256 ext. 108
Also, you may write or email a letter of complaint to the U.S. Department of Health and Human Services.
The City of Freeport will not retaliate against you for filing a complaint.