NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION (PHI)
EFFECTIVE DATE: September 1, 2013
Deseret Mutual Benefit Administrators ("DMBA") is committed to protecting your privacy with respect to
personal information we collect as your group health plan and benefits administrator. This Notice will clarify our duties
and privacy practices, as well as your privacy rights.
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.
- REASONS WE MAY DISCLOSE YOUR PHI WITHOUT YOUR AUTHORIZATION
- Treatment, Payment, and Operations Purposes:
Family and Friends Involved in your Care or Payment of a Claim: If you are available and do not object, we
may disclosure PHI to a family member or friend involved in your care or payment of your claim.
- Treatment includes the provision, coordination, or management of health-care related services by one or more health-care providers
Payment includes activities on behalf of providers and plan regarding the provision of benefits from a health
plan, including but not limited to, actions related to making coverage determinations and payment (billing,
claims management, subrogation, plan reimbursement, review for medical necessity, and appropriateness
of care and preauthorization).
Operations includes health-care operations, including but not limited to, quality assessment and
improvement, population-based activities, rating provider and plan performance, underwriting, audits and
fraud detection, and business planning.
REASONS WE MAY NOT DISCLOSE PHI WITHOUT YOUR AUTHORIZATION
- As permitted or required by law
For public health activities and public health oversight. (i.e., civil or criminal investigations, inspections,
licensure/disciplinary actions, Medicare fraud investigations)
- For legal proceedings, to law enforcement, or to a coroner or medical examiner
- For research, subject to conditions
- For worker's compensation purposes
YOUR INDIVIDUAL PRIVACY RIGHTS
Psychotherapy Notes. Psychotherapy notes require specific authorization by you. Psychotherapy notes are
defined as separately filed notes about your conversations with a mental-health professional during a
counseling session. Psychotherapy notes do not include summary information about mental health
treatment such as diagnoses, appointment dates and times, prescriptions (this information may be disclosed
under a general authorization).
Marketing Purposes. Your written authorization is required before DMBA may use and disclose
your PHI for marketing purposes. Marketing purposes includes all treatment and health-care operations
communications where DMBA receives remuneration for making the communications from a third
party who is marketing a product or service, subject to certain exceptions.
- And All Other Purposes Not Named in this Notice
Your Privacy Rights You have the right to:
- Request restrictions on your PHI uses and disclosures
- Inspect and copy your PHI
- Amend your PHI
- Receive an accounting of PHI disclosures
- Receive a paper copy of this Notice upon request
- To be notified of a breach of your unsecured PHI
- Receive copies of your PHI in electronic format
Personal Representatives: You may designate a personal representative to exercise your rights on your behalf.
Proof of authority must be shown in the form of a power of attorney for healthcare purposes notarized by a
notary republic, a court order of appointment of the person as a conservator or guardian of the individual, a
parent of a minor child. DMBA may in its discretion deny access to your personal representative.
WHOM TO CONTACT WITH CONCERNS
Changes to this Notice: DMBA must comply with this Notice and may in its discretion modify its
contents at any time. If changes are made, you will receive a revised Notice.
Minimum Amount Necessary: DMBA will make reasonable efforts to use and disclose only the
minimum amount of PHI necessary to accomplish the purpose or request.
Genetic Information (GINA): DMBA may not use or disclose genetic information for underwriting
De-identified Information: DMBA may use and disclose information that does not identify you
Disclosure to the Plan Sponsor: DMBA may use and disclose to the plan sponsor "summary health
information" (summary claims history, claims expenses, or type of claims experience) that does not include
your identifying information, for purposes of obtaining premium bids or modifying, amending, or
terminating the group health plan.
Fundraising: DMBA may not use and disclose your PHI for fundraising purposes if you have opted
out of fundraising communications.
If you have concerns or would like to report a problem please contact:
DMBA HIPAA Officer, P.O. Box 45530, Salt Lake City, Utah 84145
Telephone (801) 578-5600 or 1-800-777-3622, Fax (801) 578-5906
You may also file a complaint with the United States Department of Health and Human Services, Office for Civil
Rights (OCR). Complaints must be in writing and can be filed either by mail or electronically. OCR will provide
further information on its website about how to file a complaint (www.hhs.gov/ocr/hipaa/). Please note that
there will be no retaliation for filing a complaint.