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If the Plan or its business associate maintains electronic records of your PHI, you may request an electronic
copy of your PHI. You may also request that your electronic records be sent to a third party.
You have a right to amend PHI about you that is maintained by the Plan.
Your request must be in writing and you must give a reason for the request. Your right to amend is limited.
For example, you can only amend information that is available to you under your right of access. The Plan
may deny your request if the information was not created by the Plan and the creator of the information is
available to respond to your request. The Plan may deny your request if the information is accurate and com-
plete.
You have a right to receive an accounting of some (but not all) disclosures made by the Plan.
You may request an accounting of disclosures of your PHI made within the six-year period just before the
date of your request. Your request must be in writing. The accounting will not include disclosures the Plan is
permitted to make for treatment, payment and health care operations, or those made with your authoriza-
tion. The accounting will not include disclosures made to you or close family members involved in your care.
The accounting will not include disclosures made for purposes of national security, incidental to otherwise
permitted or required disclosures, as part of a limited data set or to correctional institutions or law enforce-
ment officials. Your right to an accounting may be suspended in the event of certain government activities. If
you request more than one accounting within a 12-month period, the Plan may charge you a cost-based fee
for the additional requests.
You have a right to receive a paper copy of this notice.
If you have agreed to receive this notice by e-mail, you also have a right to receive a paper copy upon re-
quest.
You have a right to receive notification of a breach of your PHI.
You will be notified if your unsecured PHI is acquired, accessed, used or disclosed in a manner that is not per-
mitted under HIPAA and the security or privacy of your PHI is compromised.
Complaints
You may complain to the Plan or to the Secretary of the U.S. Department of Health and Human Services if you
believe your privacy rights have been violated.
Complaints to the Plan should be directed to
the Plan’s Privacy Official
using the contact information at the
end of this notice. If your complaint is with an insurer, you may file a complaint with the individual named in
the insurer’s notice of privacy practices to receive complaints. Retaliation against a person who files a com-
plaint is prohibited.
To file a complaint with the Secretary of the U.S. Department of Health and Human Services, you must submit your
complaint in writing, either on paper or electronically, within 180 days of the date you knew or should have known that
the violation occurred. You must state who you are complaining about and the acts or omissions you believe are viola-
tions of HIPAA’s privacy