Sutter Health Plus Notice of Privacy Practices
This notice describes how Sutter Health Plus may use and disclose medical information about you and how you can get access to this information. Please review it carefully.
Who Will Follow This Notice
This notice is for participants enrolled in Sutter Health Plus.
Sutter Health Plus is part of the Sutter Health Affiliated Covered Entity, a designation for purposes of the Health Insurance Portability and Accountability Act (HIPAA). When you are both a member of Sutter Health Plus and a patient of Sutter Health, Sutter Health Plus and Sutter Health may use and disclose your information as permitted under HIPAA and state law. Any disclosure of medical information beyond the provisions of the law is prohibited.
For purposes of this notice, your medical information is information Sutter Health Plus collects, maintains, uses and/or discloses, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition, the provision of health care to you; or the past, present, or future payment for health care furnished to you. It includes genetic information as defined under Title I of the Genetic Information Nondiscrimination Act of 2008. Sutter Health Plus may obtain this information from you or your health care providers.
State Law
We will comply with more stringent state law to the extent applicable.
Your Rights
When it comes to your health information, you have rights. You may contact the Sutter Health privacy office at (800) 500-1950 to exercise the following rights:
- Access to an electronic or paper copy of your health and claims information.
- Ask to see or get an electronic or paper copy of your health and claims information we have about you.
- You must put your request in writing and in most cases we will provide you with access to your health and claims information. In limited cases, we may deny your request. If we deny your request, we will tell you why.
- We will provide a copy or, if you prefer, a summary of your health and claims information, usually within 30 days of your request, or within a shorter timeframe as required under applicable state law. We may charge a reasonable, cost-based fee.
Ask us to correct your health and claims information
- You can ask us to correct health and claims information about you that you think is incorrect or incomplete. You must put your request in writing and tell us why the information should be amended.
- We may say “no” to your request, but we will tell you why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way, such as telephone or mail, or to send mail to a different address.
- To make a request, you can complete and submit the Request for Confidential Communication form available online at sutterhealthplus.org or call Member Services at (855) 315-5800.
- We will honor any reasonable request, if readily producible in the requested form and format.
Ask us to limit what we use or share
- You can ask us, in writing, not to use or share certain health information for treatment, payment, our operations, or for certain notifications and to individuals involved in your care or payment for your care. In appropriate cases, we will limit sharing that information and communicate directly with you.
Get a list of those with whom we have shared information
- You can ask for a list (accounting) of the times we have shared your health and claims information for up to six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. Call Member Services at (855) 315-5800.
Choose someone to act for you
- If you have given someone medical power of attorney, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting:
Privacy and Information Security Office
9100 Foothills Blvd
Roseville, CA 95747
(855) 771-4220 - You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:
200 Independence Avenue, S.W.
Washington D.C., 20201
(877) 696-6775 - We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. Let us know if you have a clear preference for how we share your information in the situations described below. We will follow your instructions where we can.
In these cases, you have both the right and choice to tell us to:
- Share (or not share) information with your family, close friends, or others involved in payment for your care.
- Share information in a disaster relief situation.
If you are not able to tell us your preference, for example if you are unconscious, we may still be able to share minimal information if we believe it is in your best interest or when needed to lessen a serious and imminent threat to health or safety.
Our Uses and Disclosures
We use or share your health information in the following ways.
Help manage the health care treatment you receive
We can use your health information and share it with professionals who are treating you. We may also share your health information with others who provide care to you such as hospitals, nursing homes, doctors, nurses, or others involved in your care.
Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.
Run our organization
We can use and share your health information to run our group health plan, improve your care, and contact you when necessary. We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage.
Example: We use health information about you to manage your treatment and services.
We may use and share your health information to support necessary business, legal, auditing, financial and clinical functions. Examples of these functions may include: auditing our clinical procedures, analyzing our cost of care, rating our risk and determining our premiums for your health plan, quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, and conducting training programs, accreditation, certification, licensing or credentialing activities.
Bill and pay for your services
We may use or disclose your health information to pay claims from physicians, hospitals and other providers for services delivered to you that are covered by the health plan, to determine your eligibility for benefits, to coordinate benefits, to examine medical necessity, and to obtain premiums. We may disclose your medical information to a health care provider or other entity so they can obtain payment or engage in these payment activities. We will not disclose medical information related to sensitive health care services to the policyholder, primary subscriber, or any health plan member other than the individual receiving care, without a written authorization.
Example: We use your health information to determine the amount of payment owed to a health care provider.
Administer your plan
We may disclose your health information to your health plan sponsor for plan administration.
Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We will only share your information as permitted by state and federal law.
We must meet many conditions in state and federal law before we can share your information for these purposes.
Help with public health and safety issues
We can share health information about you for certain situations such as:
- Preventing disease.
- Helping with product recalls.
- Reporting adverse reactions to medications.
- Reporting suspected abuse, neglect, or domestic violence.
- Preventing or reducing a serious threat to anyone’s health or safety.
Do research
We can use or share your health information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
Work with a medical examiner
We can share health information with a coroner or medical examiner when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
- For workers’ compensation claims.
- For law enforcement purposes or with a law enforcement official.
- With health oversight agencies for activities authorized by law.
- For special government functions such as military, national security, and presidential protective services.
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Business Associates
There are some services provided in our organization through contracts with business associates, for example, administering health care claims. When services are provided by contracted business associates, we may disclose the appropriate portions of your health information to them so they can perform the job we have asked them to do. However, our business associates are also required by law to safeguard your information.
Other Uses of Health Information
Uses and disclosures of health information that are not discussed by this notice or required by law will only be made with your written permission. Your written authorization will typically be required for most uses and disclosures of psychotherapy notes, if you receive treatment in an addiction treatment program, most uses and disclosures for marketing and most arrangements involving the sale of health information.
We comply with state and federal laws that require extra protection for your health information. This includes confidential treatment of health information for sensitive services such as services for mental and behavioral health, sexual and reproductive health, and substance use. We will not disclose medical information about sensitive services without your express written consent. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time.
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your health information. We have policies and procedures designed to prevent and address such situations.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
- We have established and follow policies to protect oral, written and electronic information across the organization.
Changes to the Terms of this Notice
We may change our Notice of Privacy Practices from time to time. The changes will apply to all health and claims information we have about you. A copy of the notice that is currently in effect will be given to new health plan members. The new notice will be available to all members upon request and the notice currently in effect will be posted on the plan website.
Contact
If you have any questions, you may contact:
Privacy and Information Security Officer
9100 Foothills Blvd
Roseville, CA 95747
(855) 771-4220
Effective Date: September 30, 2022