Notice of Privacy Practices
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Medicare Notice of Privacy Practices
FLORIDA HEALTH CARE PLAN, INC.
NOTICE OF PRIVACY PRACTICES
Effective May 30, 2019
This notice describes how medical information about you may be used and
disclosed and how you can get access to this information. Please review
Our Pledge Regarding Protected Health Information
Florida Health Care Plan (FHCP) creates a record of the care and services
you receive from FHCP. We need this information to provide you with quality
care, administer your health care benefits, and comply with certain legal
requirements. This notice applies to all of the records containing protected
health information generated by FHCP. We understand that medical information
about you and your health is personal and we are committed to protecting it.
Florida Health Care Plan (FHCP) will take every reasonable action to protect
your health care information including the protection of your verbal,
written, and electronic protected health information (e-PHI) using all
means necessary while ensuring that the information is readily available
to the providers that deliver your health care. FHCP implements appropriate
administrative, technical, and physical safeguards to protect your health
information across the organization from unintended or unauthorized use,
disclosure, modification or loss.
This Notice of Privacy Practices describes how FHCP may use and disclose
your protected health information to carry out treatment, payment or health
care operations and for other purposes that are permitted or required
by law. It also describes your rights to access and control your protected
health information. "Protected health information" is information
about you, including demographic information, that may identify you and
that relates to your past, present or future physical or mental health
or condition and related health care services.
This notice describes the privacy practices of FHCP including:
• All divisions and departments of FHCP.
• All employees, staff and other FHCP personnel.
• All FHCP volunteers and auxiliary staff.
Uses and Disclosures of Protected Health Information for Treatment, Payment
or Health Care Operations
Your protected health information may be used and disclosed by FHCP’s
staff and others outside of our offices that are involved in the delivery
of health care services and benefits. Your protected health information
may also be used and disclosed to pay your health care bills and to support
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Following are examples of the types of uses and disclosures of your protected
health care information that we are permitted to make. These examples
are not meant to be exhaustive, but to describe the types of uses and
disclosures that may be made.
Treatment: We will use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services. This
includes the coordination or management of your health care with third
parties. For example, we would disclose your protected health information,
as necessary, to a home health agency that provides care to you. We will
also disclose protected health information to other physicians who may
be treating you. For example, your protected health information may be
provided to a physician to whom you have been referred to ensure that
the physician has the necessary information to diagnose or treat you.
In addition, we may disclose your protected health information from time-to-time
to another physician or health care provider (e.g., a specialist or laboratory)
who, at the request of your physician, becomes involved in your care by
providing assistance with your health care diagnosis or treatment.
Payment: We may use or disclose your protected health information, as needed, to
bill or make payment for your health care services. This may include certain
activities that we take before we approve or pay for your health care
services such as; making a determination of eligibility or coverage for
insurance benefits, reviewing services provided to you for medical necessity,
and undertaking utilization review activities. For example, we may ask
for a copy of your medical record from a hospital where you received services
to ensure that their bill was appropriate.
Health Care Operations: We may use or disclose, as-needed, your protected health information in
order to support FHCP’s business activities. These activities include,
but are not limited to, quality assessment activities, employee review
activities, training, licensing, and educational activities, and conducting
or arranging for other business activities.
For example, we may use your protected health information during medical
utilization reviews. In addition, we may use a sign-in sheet at the registration
desk where you will be asked to sign your name and indicate your physician.
We may also call you by name in the waiting room when your physician is
ready to see you. We may use or disclose your protected health information,
as necessary, to contact you to remind you of your appointment.
We will share your protected health information with third party "business
associates" that perform various activities (e.g., case management,
out-of-area claims re-pricing). Whenever an arrangement between FHCP and
a business associate involves the use or disclosure of your protected
health information, we will have a written contract that contains terms
that will protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary,
to provide you with information about treatment alternatives. We may also
use and disclose your information for educational activities. For example,
your name and address may be used to send you a newsletter.
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Disclosures of Protected Health Information (PHI) to Plan Sponsors:
With the exception of self-funded groups, Florida Health Care Plans (FHCP)
does not disclose Personal Health Information (PHI) to plan sponsors.
FHCP may provide plan sponsors summary health information in a form that
has been de-identified. De-identifying health information includes removing
things such as name, date, diagnosis, address, medical record number,
and any other unique identifying number or characteristic. This information
may be used for obtaining insurance quotes or verifying enrollment status
to ensure appropriate billing.
Uses and Disclosures of Protected Health Information Based upon Your Written
Other uses and disclosures of your protected health information will be
made only with your consent, written authorization or opportunity to object
unless required by law as described below. Without your authorization,
we are expressly prohibited to use or disclose your protected health information
for marketing purposes. We may not sell your protected health information
without your authorization. We will not use or disclose any of your protected
health information that contains genetic information that will be used
for underwriting purposes.
You may revoke this authorization, at any time, in writing, except to the
extent that FHCP has taken an action in reliance on the use or disclosure
indicated in the authorization.
Other Required and Permitted Uses and Disclosures That May Be Made Without
Your Authorization or Opportunity to Object
In certain situations we are required or permitted to use or disclose your
protected health information. Your authorization is not required for the
following uses or disclosures:
Required By Law: We may use or disclose your protected health information to the extent
that the use or disclosure is required by law. The use or disclosure will
be made in compliance with the law and will be limited to the relevant
requirements of the law. You will be notified, as required by law, of
any such uses or disclosures.
Public Health Activities: We may disclose your protected health information for public health activities
and purposes to a public health authority that is permitted by law to
collect or receive the information. The disclosure will be made for the
purpose of controlling disease, injury or disability. We may also disclose
your protected health information, if directed by the public health authority,
to a foreign government agency that is collaborating with the public health
We may disclose protected health information to a school, about an individual
who is a student or prospective student of the school, if:
• The protected health information disclosed is limited to proof of
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• The school is required by State or other law to have such proof
of immunization prior to admitting the individual; and
• FHCP obtains and documents the agreement to the disclosure from
either; o A parent, guardian, or other person acting
in loco parentis of the individual if the individual is an unemancipated minor; or
o The individual, if the individual is an adult or emancipated minor.
Communicable Diseases: We may disclose your protected health information, if authorized by law,
to a person who may have been exposed to a communicable disease or may
otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a health oversight agency
for activities authorized by law, such as audits, investigations, and
inspections. Oversight agencies seeking this information include government
agencies that oversee the health care system, government benefit programs,
other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a public health authority
that is authorized by law to receive reports of child abuse or neglect.
In addition, we may disclose your protected health information if we believe
that you have been a victim of abuse, neglect or domestic violence to
the governmental entity or agency authorized to receive such information.
In this case, the disclosure will be made consistent with the requirements
of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health information to a person or company
required by the Food and Drug Administration to report adverse events,
product defects or problems, biologic product deviations, track products;
to enable product recalls; to make repairs or replacements, or to conduct
post marketing surveillance, as required.
Legal Proceedings: We may disclose protected health information in the course of any judicial
or administrative proceeding, in response to an order of a court or administrative
tribunal (to the extent such disclosure is expressly authorized), in certain
conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as applicable
legal requirements are met, for law enforcement purposes. These law enforcement
purposes include (1) legal processes and otherwise required by law, (2)
limited information requests for identification and location purposes,
(3) pertaining to victims of a crime, (4) suspicion that death has occurred
as a result of criminal conduct, (5) in the event that a crime occurs
on FHCP’s premises, and (6) medical emergency (not on FHCP’s
premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner or medical examiner
for identification purposes, determining cause of death or for the coroner
or medical examiner to perform other duties authorized by law. We may
also disclose protected health information to a funeral director, as authorized
by law, in order to
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permit the funeral director to carry out their duties. We may disclose
such information in reasonable anticipation of death. Protected health
information may be used and disclosed for cadaveric organ, eye or tissue
Research: We may disclose your protected health information to researchers when their
research has been approved by an institutional review board that has reviewed
the research proposal and established protocols to ensure the privacy
of your protected health information.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your
protected health information, if we believe that 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. We may also disclose protected
health information if it is necessary for law enforcement authorities
to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected
health information of individuals who are Armed Forces personnel (1) for
activities deemed necessary by appropriate military command authorities;
(2) for the purpose of a determination by the Department of Veterans Affairs
of your eligibility for benefits, or (3) to foreign military authority
if you are a member of that foreign military services. We may also disclose
your protected health information to authorized federal officials for
conducting national security and intelligence activities, including for
the provision of protective services to the President or others legally
Workers’ Compensation: Your protected health information may be disclosed by us as authorized
by and to the extent necessary to comply with workers’ compensation
laws and other similar legally-established programs.
Inmates: We may use or disclose your protected health information if you are an
inmate of a correctional facility and your physician created or received
your protected health information in the course of providing care to you.
Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the
Secretary of the U.S. Department of Health and Human Services to investigate
or determine our compliance with the requirements of Section 164.500 et. seq.
Other Permitted and Required Uses and Disclosures That May Be Made With
Your Authorization or Opportunity to Object
You have the opportunity to agree or object to the use or disclosure of
all or part of your protected health information. If you are not present
or able to agree or object to the use or disclosure of the protected health
information, then we, using our professional judgment and experience,
may determine whether the disclosure is in your best interest. In this
case, only the protected health information that is relevant will be disclosed.
We may use and disclose your protected health information in the following
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Others Involved in Your Health Care: Unless you object, we may disclose to a member of your family, a relative,
a close friend or any other person you identify, your protected health
information that directly relates to that person’s involvement in
your health care. If you are unable to agree or object to such a disclosure,
we may disclose such information as necessary if we determine that it
is in your best interest based on our professional judgment. We may use
or disclose protected health information to notify or assist in notifying
a family member, personal representative or any other person that is responsible
for your care of your location, general condition or death.
If it is in Your Best Interest: Unless you object, we may use our professional judgment and experience
with common practice to make reasonable inferences of your best interest
in allowing a person to act on your behalf to pick up filled prescriptions,
medical supplies, X-rays, or other similar forms of protected health information.
Disaster Relief: Unless you object, we may use or disclose your protected health information
to a public or private entity authorized by law or its charter to assist
in disaster relief efforts.
Deceased Individuals: If an individual is deceased, FHCP may disclose to a family member, or
other persons identified who were involved in the individual’s care
or payment for health care prior to the individual’s death, the
protected health information of the individual that is relevant to such
persons involvement, unless doing so is inconsistent with any prior expressed
preferences of the individual that is known to FHCP.
Following are your rights with respect to your protected health information.
You may exercise any of these rights by contacting our Member Services
Department as described at the end of this Notice.
You have the right to inspect and/or copy your protected health information. This means you may inspect and/or obtain a paper or electronic copy of
protected health information about you that is contained in a designated
record set for as long as we maintain the protected health information.
Applicable copying fees apply for costs associated with labor and supplies
for reproducing paper copies and creating electronic copies of your protected
A "designated record set" contains medical and billing records
and any other records that FHCP uses for making treatment and benefit
administration decisions about you.
Under federal law, however, you may not inspect or copy the following records;
psychotherapy notes; information compiled in reasonable anticipation of,
or use in, a civil, criminal, or administrative action or proceeding,
and protected health information that is subject to law that prohibits
access to protected health information. Depending on the circumstances,
a decision to deny access may be reviewable. In some circumstances, you
may have a right to have this decision reviewed.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected
health information for the purposes of treatment, payment or health care
operations. You may also request that any part of
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your protected health information not be disclosed to family members or
friends who may be involved in your care or for notification purposes
as described in this Notice of Privacy Practices. Your request must state
the specific restriction requested and to whom you want the restriction to apply.
FHCP is not required to agree to a restriction that you may request prohibiting
FHCP from using your protected health information for the purposes of
treatment, payment or health care operations. If FHCP believes it is in
your best interest to permit use and disclosure of your protected health
information, your protected health information will not be restricted.
If FHCP does agree to the requested restriction, we may not use or disclose
your protected health information in violation of that restriction unless
it is needed to provide emergency treatment. With this in mind, please
discuss any restriction you wish to request with your physician.
You have the right to restrict release of information for certain services. You have the right to request FHCP to not disclose PHI to a health plan
for a health care item or service where you paid in full out of pocket.
You have the right to request and receive confidential communications from
us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation
by asking you for information as to how payment will be handled or specification
of an alternative address or other method of contact. We will not request
an explanation from you as to the basis for the request.
You may have the right to have FHCP amend your protected health information. This means you may request an amendment of protected health information
about you in a designated record set for as long as we maintain this information.
In certain cases, we may deny your request for an amendment. If we deny
your request for amendment, you have the right to file a statement of
disagreement with us and we may prepare a rebuttal to your statement and
will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures we have
made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment,
health care operations, or authorized disclosures as described in this
Notice of Privacy Practices. It excludes disclosures we may have made
to you, to family members or friends involved in your care, or for notification
purposes. You have the right to receive specific information regarding
these disclosures made by FHCP in the six years prior to your request,
but, no earlier than the effective date of this Notice, April 14, 2003.
You may request a shorter timeframe. The right to receive this information
is subject to certain exceptions, restrictions and limitations.
You have the right to a breach notification. You have the right to be notified of any breach of your unsecured protected
health information in accordance with Federal Regulations.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
Inquiries About This Notice, Exercise Of Privacy Rights, And Complaints
If you have a question about this Notice, or you wish to exercise your
rights described in this Notice, or you believe your privacy rights have
been violated, you may contact us at: Florida Health Care Plan Member
Services Department 1340 Ridgewood Avenue Holly Hill, Florida 32117
TTY/TDD: Florida TRS Relay 711 Hours of Operations: 8:00 a.m. – 8:00 p.m.
All complaints must be submitted in writing. You will not be penalized
for filing a complaint. A complaint may also be filed with the U.S. Department
of Health and Human Services at the following address:
Office for Civil Rights U.S. Department of Health and Human Services 61
Forsyth Street, S.W., Suite 3B70 Atlanta, GA. 30323 Voice: (404) 562-7886
TDD: (404) 331-2867
FAX (404) 562-7881
Services listed below are provided by FHCP at no cost to enrollees:
- Auxiliary aids and services to help us better communicate with people with
- Relay service: TTY users should call TRS Relay 711 Hours of Operations:
8:00am – 8:00pm, 7 days a week
- Multi-language Interpreter Services available, please call us at 1-877-615- 4022.
Other Uses Of Medical Information
Other uses and disclosures of medical information not covered by this Notice
or the laws that apply to us will be made only with your written permission.
If you provide us permission to use or disclose medical information about
you, you may revoke that permission, in writing, at any time. If you revoke
your permission, we will no longer use or disclose medical information
about you for the reasons covered by your written authorization except
to the extent that FHCP has taken an action in reliance on the use or
disclosure indicated in the authorization. You understand that we are
unable to take back any disclosures we have already made with your permission,
and that we are required to retain our records of the care that we provided to you.