The Plan and Your
The federal Health Insurance Portability and Accountability
Act (HIPAA) requires that health plans maintain the privacy of your health
information. A description of your rights under HIPAA can be found in the
Plan’s HIPAA Privacy Notice, which follows and is available on request from the
NOTICE OF PRIVACY PRACTICES
IUOE LOCAL 4 HEALTH AND WELFARE FUND
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
This Notice is effective August 15, 2019 and revises the
Notice effective August 15, 2016.
If you have any questions or requests about this notice,
please contact IUOE LOCAL 4 HEALTH AND WELFARE FUND PRIVACY OFFICER, P.O. Box
660, 16 Trotter Drive, Medway, MA 02053, 508-533-1400 or 888-486-3524.
The federal Health Insurance Portability and Accountability
Act (HIPAA) requires the Local 4 Health and Welfare Fund (“the Fund” or “We”)
to maintain the privacy of your health information and to provide you with
notice of its legal duties and privacy practices with respect to your Protected
Health Information. The Fund must abide
by the terms of the Notice currently in effect.
The Fund must maintain the privacy of any information it
creates or receives that can be identified as yours as it:
- Relates to payment of health care for you, or
- Pertains to your physical or mental health condition
Identifiable information refers to health information that
- Is explicitly linked to you, and also
- Has enough data included that allows for individual identification
This is referred to as Protected Health Information, or PHI
The Fund is legally obligated to abide by the terms of the
current Notice and to let you know when and under what circumstances it needs
your authorization to use PHI and when or under what circumstances it does not
need your authorization to use PHI. The Fund must also describe such uses in
The purpose of this notice is to provide you with this
information and to notify you of your rights under HIPAA. The Fund reserves the
right to change the terms of this Notice and to make the new notice provisions
effective for all PHI that it maintains. A revised Notice will be provided to
covered individuals as required by HIPAA when the Fund makes a material change
or revision to the contents of this Notice.
The IUOE Local 4 Health and Welfare Fund does not need your
authorization to use and disclose PHI for the purposes of payment, treatment or
health care operations.
Some examples of how the Fund may use and disclose your PHI for
these purposes are provided below:
Treatment: The Fund
does not typically use or disclose your PHI for treatment purposes, but
contracts with Blue Cross Blue Shield of Massachusetts to provide you access to
a network of health care providers for treatment and to issue an explanation of
benefits statement to you for you or anyone in your family. (You can ask Blue
Cross Blue Shield in writing to distribute explanation of benefit forms
addressed only to the participant or dependent.)
Payment: The Fund now contracts with Blue Cross Blue Shield
of Massachusetts for paying medical and dental claims for you and your
dependents, and for utilization review or management of such claims. While not
typical, the Fund may need to review your PHI for payment purposes if there is
an issue involving the claims payment process.
Health Care Operations:
- To notify providers of insurance benefits whether you or
your dependents are eligible for coverage at the time of service.
- For administrative purposes, such as obtaining or renewing
stop loss coverage, or for underwriting, premium rating, and other activities
related to the creation or renewal of a contract for insurance (though the Fund
will not disclose PHI that is genetic for underwriting purposes).
- To communicate with administrators or providers of Fund benefits,
such as for the medical and dental plans of benefits or the prescription drug
- To identify groups of people with similar health problems
to give them information about treatment alternatives, educational programs, and
disease management programs.
- To comply with administrative requirements such as providing PHI as necessary to accountants and lawyers to enable them to provide accounting and legal services to the Fund.
- To disclose PHI to a third-party clinical team for review
of an appeal of denied prescription drug, dental, vision, disability (loss of
time), or hearing claims.
- To disclose PHI to the sponsor of the plan (Board of
Trustees), such as for processing an appeal of a denial of benefits or coverage.
- To coordinate benefits if you or your spouse also have coverage
through a secondary insurer or Medicare.
In addition, the IUOE Local 4 Health and Welfare Fund does not
need your authorization to use or disclose PHI:
- To comply with local, state or federal law, or for health
care oversight activities authorized by law, as for example, when a disclosure
is required by subpoena or to comply with a governmental health oversight board
investigating complaints against physicians or other health care providers.
- For public health public health activities, which generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; reduce the risk for contracting or spreading a disease or condition.
- For research under certain circumstances, including to
study treatment outcomes, costs and benefit design, after we remove information
that personally identifies you.
- When the disclosure relates to victims of abuse, neglect,
or domestic violence.
- For law enforcement purposes, including to respond to a
subpoena, warrant, summons, or similar process, or in some cases to identify or
locate a suspect or report a crime.
- For specialized governmental functions, such as to disclose an individual’s PHI to authorized federal ofﬁcials for the conduct of national security or intelligence-related activities authorized by law, including providing protection to the President or other authorized persons or foreign heads of state.
- For the duties of a coroner, medical examiner, or funeral
director, to identify the body of a deceased person, to determine a cause of
death, or to perform other authorized duties.
- For facilitating organ donation and transplants, including
release of necessary medical data to organizations engaged in the procuring,
banking, or transplanting of human organs, eyes, or tissue.
- To comply with workers’ compensation laws or other similar programs
to the extent necessary.
- To avert a serious threat to health or safety or to
prevent or lessen an imminent threat to the health and safety of another person
or the public.
- For judicial proceedings, such as in response to a court
order, subpoena or other lawful process, after the Fund is assured efforts have
been made to notify you of the request or to obtain an order protecting the
- To Business Associates acting on the Fund’s behalf and
providing services (such as legal, auditing, claims utilization review) to the
Fund. All of our Business Associates are
obligated to protect the privacy of your information and are not allowed to use
or disclose any information other than as specified in our contract with them.
- To provide legally required notices of unauthorized access
to or disclosure of your health information.
- To the correctional institution or law enforcement
official if you are an inmate of a correctional institution or under the
custody of a law enforcement official, if necessary: (1) for the institution to
provide you with health care; (2) to protect your health and safety or the
health and safety of others; or (3) the safety and security of the correctional
We may also make other uses and disclosures, which occur as
a by-product of these permitted uses and disclosures of PHI.
The IUOE Local 4 Health and Welfare Fund must have your
written authorization to disclose PHI for any other purpose, including
disclosure of PHI relating to your health and welfare claims, to someone other
than you. You may revoke such an authorization at any time in writing.
The types of uses and disclosures that require your authorization include:
- The use and disclosure of psychotherapy notes, except by the originator of the notes for treatment, by the Fund for its own supervised training programs, or by the Fund to defend itself in a legal proceeding;
- The use and disclosure of PHI for marketing, except if the
communication is in the form of a face-to-face communication by the Fund to an
individual or a promotional gift of nominal value by the Fund; and
- The disclosure of PHI which is a sale of PHI as defined by
The uses and disclosures that require us to give you an
opportunity to object and opt out:
- Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.
- We may disclose your PHI to disaster relief organizations
that seek your PHI to coordinate your care, or notify family and friends of
your location or condition in a disaster.
We will provide you with an opportunity to agree or object to such a
disclosure whenever we practically can do so.
You have individual rights with respect to PHI. You have the
- An accounting of certain disclosures of PHI, including
disclosures we have made of your PHI other than for treatment, payment, or
health care operations, for the six years prior. You must submit your request in writing.
- Inspect and copy your PHI.
You must put your request in writing.
The Fund has up to 30 days to make the information available to you, and
may charge a reasonable fee for the cost of copies, mailing or supplies
associated with your request. If your Protected Health Information is
maintained in an electronic format (known as an electronic medical record or an
electronic health record), you have the right to request that an electronic
copy of your record be given to you or transmitted to another individual or
entity. We will make every effort to
provide access to your Protected Health Information in the form or format you
request, if it is readily producible in such form or format. If the Protected Health Information is not
readily producible in the form or format you request your record will be
provided in either our standard electronic format or if you do not want this
form or format, a readable hard copy form.
We may charge you a reasonable, cost-based fee for the labor associated
with transmitting the electronic medical record.
- Amend your PHI in certain circumstances with certain
limitations, such as if you believe PHI about you is incorrect or
incomplete. You must put your request in
writing and give a reason.
- Revoke your authorization to disclose PHI at any time in writing.
- Request reasonable confidential communications of PHI by
alternative means or to alternative locations (for example, your workplace). We
may ask that you put such a request in writing, but we may not require an
explanation of the reason for the request.
- Request certain restrictions of use and disclosures of
PHI. While you have the right to request
a restriction on the Fund’s use and disclosure of your PHI, the Fund is not
required to agree to a restriction. The Fund will agree to your request for
restriction, however, if the disclosure is for payment or health care
operations purposes and the PHI pertains solely to a health care item or
service for which you have paid the Fund out of pocket in full.
You also have additional rights.
- You have the right to a paper copy of this Notice upon
- You may file a complaint about our privacy practices by
contacting the Privacy Officer at the address listed in this Notice (page 1).
You may also send a written complaint to the Secretary of the United States
Department of Health and Human Services. You may not be penalized or retaliated
against for filing such a complaint.
If the Fund experiences a breach of unsecured PHI, it will
notify affected individuals within 60 days of discovery. The Fund will also notify the U.S. Department
of Health and Human Services and local media outlets if the breach affects 500
or more individuals.
Your Board of Trustees
William D. McLaughlin, Chairman
Paul C. DiMinico
David F. Fantini
David Marr, Jr.
IUOE Local 4
William D. McLaughlin, Business Manager
Gina M. Alongi