Privacy Policy

SUMMARY OF MEDICA'S PRIVACY PRACTICES

Effective:     June 11, 2003 Reviewed:  October 3, 2006

There are several state and federal laws requiring Medica to protect our members' personal information. The most recent regulations (45 CFR parts 160 and 164) are tied to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). These regulations require health plans such as Medica to provide you with information about how your personal information may be used and disclosed. The regulations describe how Medica must protect this information and how you can access your personal information. Medica must adhere to the terms of its privacy notice. Medica may change or amend its privacy notice, however, if it's materially changed, Medica will issue you a revised privacy notice within sixty (60) days from the date it is amended.

The law permits Medica to use and disclose your personal information for purposes of treatment, payment, and health care operations without first obtaining your authorization. There are other limited circumstances in which Medica may use and disclose your personal information without your authorization such as public health, regulatory, and law enforcement activities. Whether personal information is used or disclosed with or without authorization, Medica uses or discloses personal information only to those persons who need to know and only the minimum amount necessary to perform the required activity.

The law also gives you rights to access, copy, and amend your personal information. You have the right to request restrictions on certain uses and disclosures of your personal information. You also have the right to obtain information about how and when your personal information has been used and disclosed.

These duties, responsibilities, and rights are described in more detail in Medica's Privacy Notice.

Please Note: Medica's Privacy Notice does not apply to members whose employers are self-insured. If your employer is self-insured, you need to contact your employer for more information about your health plan's 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.

THIS NOTICE IS INTENDED FOR MEDICA INSURANCE COMPANY, MEDICA HEALTH PLANS, AND MEDICA HEALTH PLANS OF WISCONSIN MEMBERS (COLLECTIVELY REFERRED TO AS "MEDICA"). IF YOU ARE A COVERED PERSON IN A SELF-INSURED GROUP HEALTH PLAN, YOU HAVE A RIGHT TO RECEIVE A PRIVACY NOTICE DIRECTLY FROM YOUR GROUP HEALTH PLAN.

Medica is committed to protecting and maintaining the privacy and confidentiality of your personal information. This notice describes our privacy practices and our related legal duties. It also describes your rights relating to personal information about you.

What is personal information?
As a health plan, Medica obtains, maintains, uses and discloses information about our members such as name, address, telephone number, Social Security number, age, date of birth, gender, marital status, dependent information, and health history. In addition, Medica obtains and generates information about our members' enrollment, physical and mental health conditions, prior approval for services, referrals, coverage determinations, claims data, medical records, and payment for health care services. This and any other information that individually identifies you is called "personal information."

How does Medica protect your personal information?
Medica takes its responsibility of protecting your personal information seriously. Where possible, Medica de-identifies or encrypts personal information. We use and disclose personal information only to the extent necessary to conduct treatment, payment and health care operations, or to comply with legal, regulatory or accreditation requirements. Medica uses and discloses only the minimum amount of personal information necessary to perform the required activity. In addition to physical and technological safeguards, Medica has adopted administrative policies and procedures that require its employees, business associates and health care providers to treat personal information as private. Medica provides training in privacy procedures to its employees. We protect the personal information of applicants and former members just as we protect the personal information of current Medica members.

Under what circumstances does Medica use or disclose personal information?
Medica and its business associates obtain, maintain, use and share personal information to carry out certain routine activities. Routine activities include: (i) treatment-related activities, such as referring you to a doctor or other provider; (ii) payment-related activities, such as paying a claim for medical services rendered; and (iii) health care operations, such as professional peer review. Other examples of routine activities include:

• Enrollment and eligibility, benefits management, and utilization management
• Customer service
• Coordination of care
• Health improvement and disease management (for example, sending information on treatment alternatives or other health-related benefits)
• Premium billing and claims administration
• Complaints (grievances) and appeals
• Underwriting, actuarial studies, and premium rating
• Regulatory and accreditation oversight, and legal compliance
• Credentialing and quality assessment
• Business planning or management and general administrative activities (for example, employee training and supervision, legal consultation, accounting, auditing)
• Anti-fraud activities
• Medica may from time to time contact you with important information about your health plan benefits. Such contacts may include telephone, mail or electronic mail messages.

With whom does Medica share personal information?
Medica shares personal information for routine activities with health care providers, accrediting organizations, regulatory agencies, law enforcement, group policyholders, and our business associates, who are under contract to provide services to or on behalf of Medica (for example, claims processing services).

There are also other activities for which Medica uses or discloses your personal information without authorization, as permitted by law. These activities include:

• public health activities (such as disease intervention);
• healthcare oversight activities required by law or regulation (such as professional licensing, member satisfaction surveys, quality surveys, or insurance regulation);
• law enforcement purposes (such as fraud prevention); and
• assisting in the avoidance of a serious and imminent threat to health or safety.

Medica has policies that limit the disclosure of personal information to employers. However, Medica must share some personal information (for example, enrollment information) with a group policyholder or its designee to administer its business. The group policyholder or designee is responsible to safeguard the personal information from being used for purposes other than administering health plan benefits.

Medica may occasionally contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Under what circumstances can you authorize Medica to use and disclose your personal information?
From time to time, Medica is interested in using or disclosing personal information for purposes other than treatment, payment, health care operations, or as required by law. In these situations, Medica is required to obtain your written authorization. Medica will not be able to release the particular personal information until we have obtained your authorization. You have the right to decide not to authorize Medica to use or disclose your personal health information in these situations. You will not encounter any adverse consequences if you elect not to authorize a particular activity. You, or your authorized representative (such as a power of attorney or court-appointed guardian), may revoke an authorization that has been given in the past, except to the extent that Medica has already relied and acted on your permission.

What are your rights to your personal information?
You have the following rights with regard to the personal information that Medica has about you. You, or your personal representative on your behalf, may:
About this notice.
Medica is required by law to maintain the privacy of personal information and to provide this notice. We reserve the right to change the terms of our notice and to make the new notice effective for all personal information that we maintain. If we make such a change, we will send you a revised notice by mail or electronically. By law, Medica must abide by the terms of the privacy notice currently in effect. This notice is effective June 11, 2003.

As used in this notice, "Medica" refers to the family of health plan businesses that includes Medica Health Plans, Medica Health Plans of Wisconsin and Medica Insurance Company. This notice is provided to subscribers enrolled in fully-insured Medica products, for the benefit of themselves and their dependents.