Abbeville Savings & Loan Benefit Plan
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.
The Abbeville Savings and Loan Benefit Plan (the "Plan") is required by the
Health Insurance Portability and Accountability Act ("HIPAA") to protect the
privacy of your personal health information held by the Plan. The Plan provides
health and/or dental benefits to you through one or more health care related
benefit programs described in your summary plan description(s). The Plan is
sponsored by Abbeville Savings and Loan (the "Company").
The Plan receives and maintains your personal health information in the course
of providing these benefits to you. The Plan hires business associates, such as
Blue Cross Blue Shield of South Carolina and the South Carolina Bankers Employee
Benefit Trust, to help it provide these benefits to you. These business
associates also receive and maintain your personal health information in the
course of assisting the Plan.
THE EFFECTIVE DATE OF THIS NOTICE IS APRIL 14, 2004. The Plan is required to
follow the terms of this notice until it is replaced. The Plan reserves the
right to change the terms of this notice at any time. If the Plan makes
significant changes to this Notice, the Plan will revise it and send a new
notice at that time. The Plan reserves the right to make the new changes apply
to all your personal health information maintained by or for the Plan before and
after the effective date of the new notice.
General Privacy Standard. Under HIPAA, the Plan and its business associates may
use or give out ("disclose") your personal health information without your
authorization (written permission) for the purposes described below unless there
is a state or federal law that provides you with greater protection of your
privacy rights than HIPAA. For example, state or federal law may require that
the Plan take additional precautions before using or disclosing certain types of
health information such as mental health records, alcohol or substance abuse
records, or prescription information. State or federal law may also give you
greater access to your personal health information than HIPAA.
The Plan will make every effort to comply with the requirements of the
applicable state or federal law and HIPAA. This means that regardless of which
law applies, your health information will be afforded the greatest level of
privacy protection and you will be granted the most access to your health
information.
Purposes for which the Plan May Use or Disclose Your Personal Health Information
Without Your Permission or An Opportunity to Agree or Object. The Plan and its
business associates may use or disclose your personal health information without
your authorization or an opportunity to agree or object for the purposes
described below. The Plan and its business associates have their own policies
and procedures to ensure these uses or disclosures are limited to the minimum
amount of your personal health information reasonably necessary to accomplish
the described purpose.
- Payment. The Plan has the right to use and disclose your personal health
information to make decisions about payment for your health care. "Payment"
includes a variety of activities, including decisions about your eligibility or
coverage; processing claims (including paying claims and seeking payment from
other responsible third parties); reviewing medical necessity, coverage,
appropriateness of care and support for charges; conducting utilization review (precertification,
concurrent or retrospective reviews); and making limited disclosures to
collection or credit reporting agencies concerning your payment of premiums.
Examples: The Plan reviews and uses information about treatment you have
received to determine whether that treatment is covered under a Benefit Program
and whether to pay or deny a claim. The Plan also uses your personal health
information to make decisions when you or your health care provider appeals the
denial of a claim.
- Health Care Operations. The Plan has the right to use and disclose your
personal health information to conduct its health care operations. "Health Care
Operations" of the Plan include quality improvement activities, case management
and care coordination and evaluating Plan performance. They also include
accreditation, licensure or credentialing activities. The Plan also conducts
activities related to creating, renewing or replacing Benefit Programs or
contracts for those programs. The Plan performs or contracts for audit, fraud
detection and compliance services. The Plan also does business planning and
development for the Plan and its Benefit Programs (including developing or
improving benefits, payment methods and coverage policies), along with general
business management and administrative activities. The Plan may also use your
personal health information to contact you about other health-related benefits
and services offered by the Plan. Examples: The Plan may use or disclose your
personal health information for the purpose of coordinating your care to reduce
the cost of your care. The Plan may also use or disclose your personal health
information when it is evaluating the financial performance of the Plan or any
of its Benefit Programs, or deciding whether to offer or continue offering
certain benefits.
- To Business Associates. The Plan may disclose your personal health information
to those business associates with whom the Plan contracts to assist the Plan in
performing the payment and health care operations activities of the Plan and its
Benefit Programs such as Blue Cross Blue Shield of South Carolina and the South
Carolina Bankers Employee Benefit Trust. Each business associate of the Plan
must agree in writing to ensure the continuing privacy and security of your
personal health information it creates, receives or uses. Certain business
associates may have the only copies of your personal health information, and
will assist the Plan in carrying out its responsibilities with regard to your
rights to access and amend that information. These rights are described below.
- To the Company as Plan Sponsor.
- The Plan may disclose to the Company as the Plan sponsor claims history and
other similar information. This will be summary information that does not
disclose your name or other distinguishing characteristics. The Plan may also
disclose to the Company as Plan sponsor the fact that you are enrolled in, or disenrolled from the Plan or any of its Benefit Programs.
- • The Plan may disclose your personal health information to certain designated
employees of the Company whose job responsibilities include assisting the Plan
in performing payment and health care operations activities for the Plan and its
Benefit Programs. The Company has agreed to ensure the continuing privacy and
security of your personal health information. The Company has also agreed not to
routinely use or disclose your personal health information for
employment-related activities or for the purpose of administering any other
benefit plans that are exempt from the HIPAA privacy regulations.
- Required by Law. The Plan may use or disclose your personal health information
to the extent required by law. These laws include any applicable federal, state
or local laws that would require the Plan or its business associates to make a
specific use or disclosure of your personal health information. The way these
disclosures are made and the amount and type of personal health information
disclosed will be limited to the legal requirement. In certain cases the Plan
may be required to notify you that a disclosure has been or will be made.
- Public Health and Health Oversight Activities. The Plan may disclose your
personal health information to public health authorities that are authorized by
state, federal or local law to collect information for purposes such as
preventing or controlling disease, injury or disability or notification of
exposure to communicable diseases. The Plan may also disclose your personal
health information to a federal, state or local agency required by law to
oversee, license, inspect or investigate programs where health related
information is collected or used.
- Lawsuits or Similar Proceedings. The Plan may disclose your personal health
information in response to a court order or an administrative order. The Plan
may also disclose your personal health information in response to a subpoena or
other type of lawful request from an attorney involved in a lawsuit, or from a
government agency or investigator involved in an administrative proceeding. In
the case of a subpoena or other lawful request, the Plan is required to make
sure you are aware of the request or obtain an assurance that your personal
health information will be used appropriately.
- Law Enforcement. The Plan may disclose your relevant personal health
information in response to a court ordered warrant, subpoena or summons; a grand
jury subpoena; or a civil investigative demand made by an agency or officer for
legitimate law enforcement inquiry.
- Coroners and Medical Examiners. The Plan may disclose your personal health
information to a coroner or medical examiner for purposes of identifying a
deceased person or determining the cause of death.
- Organ, Eye or Tissue Donation. The Plan may disclose your personal health
information to facilitate organ, eye or tissue donation or transplantation as
allowed by the state’s organ procurement laws.
- Threats to Public Health. The Plan may be required to disclose limited
personal health information to the extent the Plan in good faith determines such
disclosure is necessary to prevent or lessen a serious and imminent threat to
public health or safety, or to the health or safety of a specific individual.
- Specialized Government Functions. The Plan may be required to disclose your
personal health information to the United States or a State government if you
are an active or veteran member of the military, seeking a government security
clearance or permission to travel abroad, if you are in lawful custody, or if
the government requires such information to conduct lawful national security
activities.
- Worker’s Compensation. The Plan may disclose your personal health information
as authorized by the state’s workers compensation laws.
Purposes for which the Plan Must Give You and Opportunity to Agree or Object to
Use or Disclose Your Personal Health Information. The Plan may disclose personal
health information related to payment for your health care under the Plan to
your family members, other relatives or anyone else identified by you as
involved in your care in the following circumstances:
- If you bring the individual with you to discuss an issue arising from payment
for your health care under the Plan, unless you object or notify us otherwise at
the time we may infer from their presence that you agree we may discuss your
personal health information with that individual;
- If you are incapacitated or in a situation such as a medical emergency and
cannot agree or object, we may disclose your personal health information to your
personal representatives to assist them in obtaining payment for your health
care; or
- If you sign an authorization specifically allowing the Plan to disclose your
personal health information to such an individual.
Uses and Disclosures with Your Written Permission (Authorization). The Plan will
not use or disclose your personal health information for any purposes other than
those described above unless you give your written permission ("authorization")
to do so, using a form approved or supplied by the Plan or its business
associate. If you give a valid written authorization to use or disclose your
personal health information then, in most cases, you may revoke it in writing at
any time. Your revocation will be effective for all the personal health
information the Plan and its business associates maintain, unless the
information has already been disclosed in reliance on your prior written
authorization. Except in limited eligibility and enrollment circumstances, your
right to receive benefits under the Plan cannot be conditioned upon your signing
an authorization allowing the Plan to use or disclose your personal health
information in a manner not described in this Notice.
Your Rights. You may make a written request to the Plan to do one or more of the
following concerning your personal health information that the Plan maintains:
- To put additional restrictions on the Plan’s use and disclosure of your
personal health information. The Plan does not have to agree to your request.
- To ask the Plan communicate with you in confidence about your personal health
information by a different means or at a different location than the Plan is
currently using. The Plan does not have to agree to your request unless
necessary to avoid endangering you. Your request must specify the alternative
means or location to communicate with you in confidence.
- To see and get copies of your personal health information that is created or
maintained by the Plan or its business associates. In limited cases, the Plan
does not have to agree to your request.
- To correct your personal health information that is created or maintained by
the Plan. In some cases, the Plan does not have to agree to your request.
- To receive a list of disclosures of your personal health information that the
Plan and its business associates made for the last 6 years (but not for
disclosures made before April 14, 2004). The Plan is not required to list
disclosures made for treatment, payment or health care operations, or
disclosures made with your authorization.
- To send you a paper copy of this notice if you received this notice by e-mail
or on the internet.
If you want to exercise any of these rights described in this Notice, please
contact the designated Plan Contact at the address provided below. The Plan
Contact will give you the necessary information and forms for you to complete
and return. In some cases, the Plan may charge you a nominal, cost-based fee to
carry out your request.
Complaints. If you believe your privacy rights have been violated by the Plan,
you have the right to complain to the Plan or to the Secretary of the U.S.
Department of Health and Human Services. You may file a complaint with the Plan
Contact designated below, or ask for the address of the appropriate regional
office of the Secretary of the USDHHS. Neither the Plan nor the Company will
retaliate against you if you choose to file a complaint.
Contact Office. To request additional copies of this notice or to receive more
information about our privacy practices or to exercise any of your rights,
including your right to file a complaint, please contact us at the following
Contact Office:
| Contact Office:
|
Privacy Officer
c/o South Carolina
Bankers Association |
| Telephone:
|
803-779-0850 |
| Fax: |
803-256-8150 |
| E-mail: |
teresataylor@scbankers.org |
| Address:
|
P.O. Box 1483 Columbia,
South Carolina 29202 |