Effective date: May 3, 2017
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.
For questions or concerns about health insurance, please contact Hometown Health’s Customer Service Department. You may reach us by:
Email at email@example.com
Phone at 775-982-3232, or toll free 800-336-0123, Monday through Friday, 8:00 a.m. – 5:00 p.m.
Fax at 775-982-3741, Attention: Customer Service Department
TTY Relay Service 711
Who will follow this notice
This notice describes the practices of Hometown Health Plan, Inc. and their employees. For the purposes of this notice, the above-referenced entities, sites, and locations will be referred to in this notice as the “Hometown Health.” Hometown Health may share health information with each other for treatment, payment, or operations purposes described in this notice.
Our pledge regarding your medical information
We understand that medical information about you and your health is personal. We are committed to protecting your medical information, including nonpublic personal financial information related to your healthcare. We create a record of your benefits and eligibility status and claims history. We need this record to provide you with quality healthcare benefits and to comply with certain legal requirements. Hospitals, physicians and other healthcare providers providing healthcare services to Hometown Health members may have different policies or notices regarding their uses and disclosures of your medical information.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
Information about our members
In the course of providing healthcare benefits, we may receive the following information about you:
How we protect your medical information
At Hometown Health, we restrict access to your medical information to those employees who need it to provide services to you and your dependents. We maintain physical, electronic and procedural safeguards to protect your medical information against unauthorized access and use. For example, access to our facilities is limited to authorized personnel and we protect information we maintain electronically through the use of a variety of technical tools.
We have also established a Privacy Office, which has overall responsibility for developing, educating company personnel about, and overseeing the implementation of policies and procedures to safeguard medical information against inappropriate access, use and disclosure, consistent with applicable law.
How we may use and disclose medical information about you
Hometown Health will not disclose your medical information to anyone, except with your authorization or otherwise as permitted by law. For some activities, we must have your written authorization to use or disclose your medical information. The law, however, permits Hometown Health to use or disclose your medical information for the following purposes without your authorization:
Medical information of former members of Hometown Health
Hometown Health does not destroy the medical information of individuals who terminate their coverage with us. The information is necessary and is used for many purposes described above, even after an individual leaves a plan, and in many cases is subject to legal retention requirements. The practices and procedures that protect that information against inappropriate use or disclosure, however, apply regardless of the status of any individual member.
Your rights regarding medical information about you
You have the following rights regarding medical information we maintain about you:
Changes to this notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice on the Hometown Health Web site at www.hometownhealth.com. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you enroll in a Hometown Health Plan, we will offer you a copy of the current notice in effect. We also may publish the current notice in our newsletter on at least an annual basis.
If you believe your privacy rights have been violated, you may file a complaint with us by contacting Hometown Health Customer Services at 775-982-3112. All complaints must be submitted in writing to Hometown Health Customer Services, 10315 Professional Circle, Reno, NV 89521. You may also file a complaint with the Office for Civil Rights at www.hhs.gov/ocr.
You will not be penalized for filing a complaint.
Other uses of medical information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us permission to use or disclose medical information about you by signing an authorization, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you