PRIVACY NOTICE

FOR

WELLCARE HEALTH PLANS, INC.¹

 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BEUSED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THISINFORMATION.  PLEASE REVIEW IT CAREFULLY.

This Privacy Notice describes how WellCare may use and disclose your Protected Health Information (PHI) to carry out treatment, payment and health care operations and for other uses and disclosures that are required or permitted by law.  Additionally, this Privacy Notice explains the rights you have with respect to your (PHI), and includes certain obligations WellCare must abide by in accordance with the law.

WellCare is required by law to maintain the privacy of your health information and to provide you with this Privacy Notice outlining its legal duties and privacy practices with respect to your health information.  Nothing contained in this Privacy Notice should be construed to supercede or limit any additional rights you may be entitled to under other applicable law.  Therefore, if an applicable law affords you greater rights or more protections other than as described herein, WellCare will comply with the law that gives you greater rights and/or protections.

WellCare is required to abide by the terms of this Privacy Notice, but reserves the right to make additional changes to this Privacy Notice and to make such changes applicable to all of your health information that WellCare maintains.  If WellCare makes any material revisions to this Privacy Notice, it will provide you with a copy of the revised Privacy Notice which will specify the date on which such revised Privacy Notice becomes effective.

I.USE AND DISCLOSURE OF YOUR HEALTH INFORMATION

WellCare may use your health information for treatment, payment and health care operations.  WellCare may also use your health information for other purposes that are permitted and/or required by law and pursuant to your written authorization.  The following lists examples of how WellCare may use and/or disclose your health information.  Any other uses or disclosures not described in this Privacy Notice will only be made with your explicit written authorization, which authorization you may revoke at any time by providing WellCare with written notice of your revocation.

A.For Treatment.

WellCare may use and disclose your health information to a health care provider that provides treatment to you.  For example, WellCare may disclose your health information to a doctor, a hospital or other health care provider providing treatment to you.

B. For Payment.

WellCare will also use and disclose your health information to obtain payment for health care services or to fulfill its responsibility for coverage and the provision of benefits under WellCare.  For example, WellCare may, if appropriate, disclose your health information to Medicare or Medicaid so that we can receive reimbursement for health care treatment and services you receive.

C. For Health Care Operations.

WellCare may also disclose your health information in connection with reimbursement for operating our business.  For example, WellCare may use and/or disclose your health information to evaluate its performance or to conduct or arrange for legal services and audit functions, including fraud and abuse detection and compliance programs.  Additionally, WellCare may use your health information for its daily operations, including but not limited to, processing your enrollment, responding to your inquiries and requests for services, coordinating your care, resolving disputes, conducting medical management, quality assurance, reviewing the competence of healthcare professionals, and determining premiums.

D. For Treatment Alternatives.

WellCare may use and disclose your health information to tell you about treatment options or alternatives that may be of interest to you.

E. For Health-Related Benefits and Services.

WellCare may use and disclose your health information to tell you about health-related benefits or services that may be of interest to you.

F. To Family Members, Relatives or Close Friends.

WellCare provides you with the opportunity to identify individuals to whom you want your health information disclosed, such as family members, close personal friends or others involved in your treatment or payment for your medical care.  WellCare will only disclose the health information that is relevant to your treatment or payment.  In the event of an emergency where you are unable to communicate or object, WellCare may disclose certain health information, but only the health information that is relevant to your treatment.

G. To Business Associates.

WellCare may disclose your health information to a "business associate" that performs a function involving treatment, payment, or health care operations for WellCare.  Third party administrators, auditors, consultants, and attorneys are some examples of business associates of WellCare.

H. Other Permitted and Required Uses and Disclosures.

In some cases, WellCare may use your health information without obtaining your authorization and without offering you the opportunity to agree or object as follows:

 

• as required by law, provided however, that the use or disclosure will be made in compliance with applicable law;
• to a public health authority that is authorized by law to collect or receive such information, or to a foreign government agency that is acting in collaboration with a public health authority;
• to a health oversight agency for oversight activities authorized by law, including audits and inspections, and civil, administrative or criminal investigations, proceedings or actions;
• to a public health authority or to a government authority authorized by law to receive reports of abuse, neglect or domestic violence;
• for judicial or administrative proceedings;
• for law enforcement purposes;
• to a coroner or medical examiner to perform duties authorized by law;
• to funeral directors, consistent with applicable law, as necessary to carry out their duties;
• to organ procurement organizations or similar entities for the purpose of facilitating organ, eye or tissue donation and transplantation;
• for research purposes;
• to avert a serious threat to health or safety, so long as the disclosure is only to a person who is reasonably able to prevent or lessen such threat;
• for specialized government functions, such as the proper execution of a military mission or national security activities;
• to a correctional institution or law enforcement custodian; and
• to the extent necessary to comply with laws relating to workers' compensation or other similar programs established by law that provide benefits for work-related injuries or illness without regard to fault.

II. YOUR RIGHTS AS A PARTICIPANT IN A HEALTH PLAN

As a WellCare member, you have a number of rights associated with your health information.  The following describes your specific rights.

A. The Right to Request a Restriction or Limitation on the Use and Disclosure of Your Health Information.

You have the right to request restrictions or limitations on how WellCare is allowed to use and/or disclose your health information; however, WellCare does not have to agree to your requested restriction or limitation.  If you would like to request a restriction or limitation on WellCare’s use or disclosure of your health information, please send your written request to the address listed at the end of this Privacy Notice.  Your request must specify: (1) if you would like to restrict or limit WellCare’s use, disclosure or both; (2) what information you would like to restrict or limit; and (3) to whom you want the limitation or restriction to apply.

If WellCare agrees to a restriction or limitation of your health information, the restriction or limitation will not prevent WellCare from disclosing your health information as follows: (1) to you if you request access to your health information or if you request an accounting of disclosures; (2) for purposes required or permitted by law (e.g., to comply with laws relating to workers' compensation); or (3) in the case of an emergency, as described below.

If WellCare accepts your restriction or limitation regarding how WellCare may use or disclose your health information, WellCare may nevertheless disclose the restricted health information to a health care provider if you are in need of emergency care and your restricted health information is needed to provide emergency treatment to you.  Before WellCare discloses your restricted health information to a health care provider during an emergency, WellCare will request that the health care provider that receives your health information not further use or disclose your health information.

If WellCare accepts your requested restriction or limitation, WellCare may terminate the restriction or limitation if: (1) you agree to the termination or request the termination in writing; (2) you orally agree to the termination and the oral agreement is appropriately documented; or (3) WellCare informs you that it is terminating the restriction or limitation.; provided, however, WellCare’s termination would only be effective for health information WellCare creates or receives after it informs you of the termination.

B. Right to Request Confidential Communications Via Alternative Means or Locations.

You have the right to request receipt of health information from WellCare by alternative means or via alternative locations provided that you clearly state that the disclosure of all or part of your health information could endanger you.  For example, you may want to receive communications related to your health care at a different address other than your home address because you could be in danger of harm if someone at that address saw your health information.  If you wish to receive confidential communications via alternative means or locations, please submit your written request to the address listed at the end of this Privacy Notice and set forth the alternative means by which you wish to receive communications or the alternative location at which you wish to receive such communications.  We will accommodate all reasonable requests.

C. Right to Access Your Health Information.

You have the right of access to inspect and obtain a copy of your health information; provided, however, you are not entitled to access health information that is subject to certain legal restrictions, such as psychotherapy notes and information compiled during a legal proceeding.  To access your health information, you may send your written request to the address listed at the end of this Privacy Notice.  If you request a copy of your health information, you will receive a response to your request in a timely fashion but may be charged a reasonable, cost-based fee to cover copy costs and postage.

In some limited circumstances, WellCare may deny your request for access to health information.  For example, WellCare may deny access to health information that is subject to the Privacy Act.  WellCare may also deny you access to health information if such information was obtained from someone other than a health care provider under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information.  If your request is denied for one of the above reasons, we will provide notice of the denial.

Additionally, WellCare may deny you access to health information if: (1) access is reasonably likely to endanger the life and physical safety of you or someone else; (2) the access requested refers to another person and your access is reasonably likely to cause substantial harm to such other person; or (3) you are the personal representative of another individual and a health care professional determines that your access is reasonably likely to cause substantial harm to the individual or another person.  If you are denied access for one of these reasons, you are entitled to review by a health care professional, designated by WellCare, who was not involved in the decision to deny access.  If access is ultimately denied, you will be entitled to written explanation of the reasons for the denial.

D. Right to Receive an Accounting of Disclosures.

You have the right to receive a list of certain instances in which we or our business associates have disclosed your information for purposes other than treatment, payment, or health care operations, and certain other activities for the period of six (6) years prior to the date on which you request an accounting of disclosures, or such lesser period as you indicate.  If you would like to receive an accounting of disclosures, please send your written request to the address listed at the end of this Privacy Notice.  You will receive a response to your request for an accounting of disclosures no later than sixty (60) days after your request is received.

Notwithstanding the foregoing, your accounting of disclosures will not include any disclosures made: (1) to carry out treatment, payment and/or health care operations; (2) directly to you; (3) incident to a use or disclosure otherwise permitted by law; (4) pursuant to your authorization; (5) to persons involved in your care; (6) for national security or intelligence purposes as permitted by law; (7) to correctional institutions or law enforcement officials as permitted by law; (8) as part of a limited data set in accordance with law; or (9) that occurred prior to April 14, 2003.

You will receive one request annually free of charge and, thereafter, WellCare may charge you a reasonable, cost-based fee for each subsequent request for an accounting of disclosures within the same twelve-month period.  WellCare will notify you of the cost for an accounting of disclosures and you may choose to withdraw or modify your request before it charges you for any costs.

E. Right to Amend Your Health Information.

If you believe WellCare has health information about you that is incorrect or incomplete, you may make a written request to WellCare stating the reasons to support your requested amendment.  You have the right to request an amendment to your health information for so long as WellCare maintains your health information.  If you would like to amend your health information, please send your written request to the address listed at the end of this Privacy Notice.  If WellCare does not have your health information in its possession, it will provide you with the appropriate contact information when your request is received.  You will receive a response to your request for an amendment no later than sixty (60) days after WellCare receives your request.  However, WellCare may deny your request for amendment if, for example, WellCare determines that it did not create your health information or your health information is already accurate and complete.  You may respond to a denial by WellCare by filing a written statement of disagreement, but WellCare has the right to rebut your disagreement.  If this occurs, you have the right to request that your original request, WellCare’s denial, your statement of disagreement, and WellCare's rebuttal be included in future disclosures of your health information.

F. Right to Receive a Paper Copy of Your Privacy Notice.

You have the right at any time to obtain a paper copy of this Privacy Notice, even if you receive this Privacy Notice electronically.  If you have received an electronic copy of this Privacy Notice, but would like to obtain a paper copy of this Privacy Notice, please send your written request to the address listed at the end of this Privacy Notice.

III.MISCELLANEOUS

A. Complaints.

If you believe your privacy rights have been violated, you may file a complaint with WellCare or with the Secretary of the Department of Health and Human Services (HHS).  If you would like to filea complaint with WellCare, please forward your written complaint to the address listed at the end of this Privacy Notice or call the phone number on your ID card.  To file a complaint with HHS, you may submit it in writing or you may e-mail it to ocrcomplaint@hhs.gov.  If you choose to file a complaint, WellCare is prohibited by law from retaliating against you for filing such complaint.

B. Effective Date.

This notice is effective as of October 1, 2009.

C. Contact Information.

If you need any additional information about this Privacy Notice, please contact:

WellCare Health Plans, Inc.
Attention: Privacy Officer
P.O. Box 31372
Tampa, FL 33631-3372
www.wellcare.com

 

Last modified: 10/01/2009