Oklahoma Office of Management and Enterprise Services
Employees Group Insurance Division
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 Oklahoma Office of Management and Enterprise Services Employees Group Insurance Division (OMES EGID) is a State of Oklahoma governmental agency created and governed by Oklahoma law for the purpose of administering health, life, disability, and dental benefits to state, local government, and education employees, and other groups designated by statute, including each of the preceding group’s respective retirees.
Oklahoma privacy laws and the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) govern the privacy of an individual member’s health information. Information contained in an OMES EGID member’s file is confidential by law and OMES EGID is committed to protecting the privacy and security of members’ information. This notice describes and gives you examples of how OMES EGID will use and disclose your health information. It also provides you with information about your rights and OMES EGID’s legal duties and practices regarding this information. OMES EGID is required to abide by the terms of the Notice currently in effect.
The health claims you submit, or health claims submitted by providers for your treatment, contain protected health information and are processed for payment and data collection by claims administrators according to contract terms with OMES EGID. OMES EGID and its claim administrators use and disclose your protected health information (PHI) for:
- Treatment, such as providing PHI to a medical provider to enable treatment of your condition;
- Payment, including such processes as subrogation, or coordination of benefits with another payer; and
- Healthcare Operations, such as development or improvement of methods of payment or coverage policies, or case management and care coordination.
Contract terms with each of its claims administrators state that the claims administrator is a Business Associate as defined in OMES EGID Rules, with obligations to protect members’ information.
Your health information is used and disclosed by OMES EGID employees and other entities under contract with OMES EGID according to the “minimum necessary” standard. OMES EGID or its claims administrators may use and disclose health information for plan operations that include: providing customer service, resolving grievances, conducting activities to improve members’ health and reduce costs, case management and coordination of care, and premium rate setting activities.
OMES EGID provides limited member information to participating plan sponsors for enrollment purposes and premium comparison.
OMES EGID is permitted or required by law to make certain other uses and disclosures of your PHI without your authorization, including:
- any purpose required by law, such as a court order;
- public health activities, such as reporting of disease, injury, birth and death, and for public health investigations;
- to proper authorities, as required by law, when there is reason to suspect abuse, neglect or domestic violence;
- if authorized by law, to a government oversight agency (e.g., a state insurance department) conducting audits, investigations, or civil or criminal proceedings;
- in the course of a judicial or administrative proceeding (e.g., to respond to a subpoena or discovery request);
- to the proper authorities for law enforcement purposes;
- to coroners, medical examiners, and/or funeral directors consistent with law;
- for cadaver organ, eye, or tissue donation;
- for research purposes, but only as permitted by law;
- to avert a serious threat to health or safety;
- for other specialized government functions such as national security or intelligence activities, and as required by armed forces services, if you are a member of the military;
- to workers’ compensation agencies if necessary for your workers’ compensation benefit determination; and
- if required by law, release your PHI to the Secretary of the Department of Health and Human Services for enforcement of HIPAA.
OMES EGID will ask for your written permission before it uses or discloses your health information for purposes that are not described in this Notice. You may withdraw such permission in writing at any time. OMES EGID will no longer use or disclose health information about you for the reasons covered by your written permission, except to the extent that OMES EGID has already taken action in reliance on your authorization.
You have the right to:
- inspect and copy your health information (generally EOBs), with the exception of psychotherapy notes and/or information that requires a court order. OMES EGID may impose a reasonable, cost-based fee, for copies provided or for preparation of additional explanations or summaries of the PHI;
- amend and restrict the health information that OMES EGID discloses about you; however, OMES EGID is not required to agree to a requested restriction;
- request your communications with OMES EGID regarding your protected health information be handled through alternative means or at alternative locations;
- receive a paper copy of this Notice upon request, if you received this Notice electronically;
- file a complaint if you believe OMES EGID improperly used or disclosed your information;
- request a listing of your protected health information disclosed by OMES EGID except that, as a health plan, OMES EGID is not required to account for disclosures for claims payment or health care operations, disclosures you requested pursuant to your written Authorization or made directly to you, and other disclosures as permitted under HIPAA.
OMES EGID reserves the right to change the terms of this Privacy Notice and will provide all interested persons a revised notice either by U.S. Postal Service delivered to the individual’s mailing address on file with OMES EGID or through electronic communication by posting the revised Privacy Notice on the OMES EGID website at www.ok.gov/sib and www.healthchoiceok.com
If you believe your privacy rights have been violated, you may file a written complaint with OMES EGID or with the U.S. Department of Health and Human Services (HHS) through the Office of Civil Rights. No retaliation is allowed against the individual filing a complaint. Complaints to HHS must be filed within 180 days after the date on which you became aware, or should have been aware, of the violation.
To file a complaint with OMES EGID, contact:
OMES EGID HIPAA Privacy Officer
3545 NW 58th, Suite 1000
Oklahoma City, OK 73112
Telephone: 1-405-717-8701, toll-free 1-800-543-6044
TDD 1-405-949-2281, toll-free TDD 1-866-447-0436.
Effective Date: October 1, 2012