CareSource 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.

CareSource respects your right to privacy. This notice explains how, when and why we use or share the personal health information (PHI) we keep about you.

• Your PHI includes information used to identify you and to keep track of:
• Your health.
• Your medical treatment.
• Payment for the health care you receive.

This notice also explains your rights with respect to your PHI.

Contact us about your PHI at:

CareSource Privacy Officer

CareSource

One S. Main St.

Dayton, OH  45402

Or by telephone at (800) 488-0134, extension 2023.

How and When We Use or Share Your PHI

We are required by law to keep your PHI private. We must give you this notice of our legal duties. We must tell you how we keep your PHI private. Below are the ways the law allows or requires us to use or share your PHI without getting your permission.

To pay claims. – We may use or share your PHI to pay for health services you get. For example, we may use it to make sure the services you get are covered by CareSource. We may also give your PHI to another health plan that may need it to process and pay claims for you.

To operate our business. – We may use or share your PHI to administer our health plan. For example, we may use it to:

• Review and improve the quality of health care you receive.
• Remind you of an appointment.
• Tell you about a different type of treatment.
• Send you health information.

Sometimes we give your PHI to other people who help us do our work. They include lawyers, accountants or others. They must keep your PHI private, too.

So you can get treatment. – We may share your PHI with a friend, a family member or others. We would do this when you need care and are not able to make decisions. For example, if you are unconscious, we may share your PHI with a relative. We would do this so they can help you get the care you need. If you are able to decide for yourself, we will not share your PHI with others unless you ask us to.

Other uses and disclosures – We may share your PHI:

• For any purpose required by law.
• For public health reports on diseases, injuries, births or deaths.
• If we think you or a child is involved in abuse, neglect or domestic violence.
• If a government agency is doing an investigation.
• If a court tells us to. (In most cases, you will be notified of this.)
• To report crimes or injuries to law enforcement agencies.
• To identify a deceased body or learn the cause of death.
• To arrange an organ or tissue donation or transplant for you.
• For research approved by an institutional review board that has rules to ensure privacy.
• If you are a member of the military or for national security activities.
• To obey workers’ compensation laws.
• If we believe, in good faith, that it is needed to save someone else’s health or life.

We will not use or share your PHI for any other purpose unless you sign a form that permits us to. If you sign a form then change your mind, you can take back your permission for future uses. You can do this by writing to the CareSource Privacy Officer.

Special rules – Under Indiana law, we must get your okay before we share:

• The results of an HIV test.
• A diagnosis of AIDS or an AIDS-related condition.
• Information about drug or alcohol treatment.
• Information about mental health care.
• Certain PHI with Indiana’s long-term care investigators.

For full details of when this is needed, please contact our privacy officer.

Your Rights

You have the right to:

• Look at or get copies of your PHI that we have. This should happen within 30 days of your request.
• Get a list of times we have shared your PHI after April 14, 2003.
• Ask us to change or correct your PHI. Your request must include your reason for it. We will carefully consider all requests. We are not required to make them. If we do make a change, we may need to tell others who work with us and have copies of the uncorrected records.
• Ask us to limit how we use or share your PHI. We will carefully consider all requests. We are not required to make them. If we do, you and CareSource have the right to cancel the agreement. If we cancel it, we will notify you.
• Ask us to send things that include your PHI in another way or to another place. For example, you may not want messages on your answering machine. Or you might want things mailed to a dif-ferent address. We will fulfill requests that show us how it would be a danger to you if we don’t.

Please make these requests in writing. You or your representative must sign the request. You can get a request form from our privacy officer. You don’t have to use a form. Please send all requests to our privacy officer. If we make a requested change, it will expire 60 days from the date of the request.

You also have the right to:

• Get a paper copy of this notice.
• File a written complaint if you feel your privacy rights have been violated. Send complaints to our privacy officer. You can also send them to the Secretary of the U.S. Department of Health and Human Services. Please send them within 180 days of when you think your rights were violated. You will not be punished for filing a complaint.

Effective Date

This notice is effective April 14, 2003. We must follow these rules as long as this notice is active. If needed, we can change the notice. The new one would apply to all PHI we keep. If this happens, we will mail you a copy of the new one. You can ask for a paper copy of our notice at any time. Just mail a request to our privacy officer. Thank you.