Privacy Notice

How We May Use and Disclose Health Information about You

The following categories describe different ways that we use and disclose health information.

• For Payment    We may use or disclose health information about you to determine eligibility for plan benefits, obtain customer payment for benefits, process and pay your claims, administer plan responsibility for benefits, and to coordinate benefits.  For example, payment functions may include reviewing submitted claims or determining whether a treatment is covered under your plan.
• For Health Care Operations    We may use and disclose health information about you to administer necessary activities related to your coverage.  For example, setting rates, conducting assessment and improvement activities, reviewing your treatment, fraud and abuse detection, and general administration.
• Health-Related Benefits and Services    We may use or disclose health information about you to communicate to you about health-related benefits and services.  For example, we may communicate to you about health-related benefits and services that add value to, but are not part of, your health plan.
• Personal Representatives    We may use or disclose health information about you when dealing with individuals involved in your care or the payment for your care.  For example, we may disclose health information to an individual who has legal authority to make health care decisions on your behalf.
• Research    We may use or disclose health information about you for research purposes.  If we do, Delta Dental may be required to obtain an authorization from you for such use or disclosure.

Other categories describing how we may use and disclose your health information are listed below, along with some examples of these uses and disclosures.

• As Required by Law    For example, when required in a litigation proceeding such as a malpractice action and/or as required by federal or state statute or regulation.
• To Avert a Serious Threat to Health or Safety    For example, to prevent or lessen a serious and imminent threat to the health or safety of a person or the general public.
• Military and Veterans    For example, if required by military command authorities.
• Worker’s Compensation    For example, to comply with workers’ compensation or similar laws.
• Public Health Risks    For example, to prevent or control disease, report child abuse, and domestic violence.
• Health Oversight Activities    For example, to help health agencies during audits, investigations or inspections.
• Lawsuits and Disputes    For example, in the course of any administrative or judicial proceeding.
• Law Enforcement    For example, to identify or locate a suspect or to comply with a court order, a court ordered warrant or a subpoena or summons issued by an officer of the court.
• National Security and Intelligence Activities    For example, for military, national security, prisoner and government benefit purposes.
• Disclosures to Plan Sponsors    For example, to help the sponsor of your group health plan administer your benefits.

When Delta Dental May Not Use or Disclose Your Health Information

Delta Dental will use or disclose your health information only as described in this Notice.  It is not necessary for you to do anything to allow us to disclose your health information as described here.  If you want us to use or disclose your health information for another purpose, you must authorize us to do so; you may revoke your authorization in writing at any time.  If you revoke your authorization, we will no longer be able to use or disclose health information about you for the reasons covered by your written authorization, though we will be unable to take back any disclosures we have already made with your permission.

Your Rights Regarding Health Information About You

You have the following rights regarding health information we maintain about you:

• Your Right to Inspect and Copy Your Health Information    To inspect and copy such information, you must submit your request in writing.  If you request a copy of the information, we may charge you a reasonable fee to cover expenses associated with your request.
• Your Right to Amend Incorrect or Incomplete Information    You may request that Delta Dental change your health information, although we are not required to do so.  If your request is denied, we will provide you with information about our denial and how you can disagree with the denial.  To request an amendment, you must make your request in writing.  You must also provide a reason for your request.
• Your Right to an Accounting of Disclosures Made by Delta Dental    You may request an accounting of disclosures made for purposes other than payment functions or health care operations or made to you.  You must submit your request in writing.  Your request should specify a time period of up to six years and may not include dates before April 14, 2003.  Delta Dental will provide one list per 12-month period free of charge; we may charge you for additional lists.
• Your Right to Request Restrictions on Uses and Disclosures    Although you have this right, Delta Dental is not required to agree to the restrictions that you request.  If you would like to make a request for restrictions, you must submit your request in writing.
• Your Right to Request Confidential Communications through a Reasonable Alternative Means or at an Alternative Location    To request confidential communications, you must submit your request in writing.  We are not required to agree to your request, unless such disclosure could cause you to be in danger.
• Your Right to a Paper Copy of This Notice    You may obtain additional paper copies of this Notice by sending us a written request. 

Send us a written request if you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights.

Changes to This Notice

Delta Dental can amend this Notice at any time in the future and make the new Notice provisions effective for all health information that we maintain.  We will promptly revise our Notice and distribute it to you whenever we make significant changes.  Until then, Delta Dental is required by law to comply with the current version of this Notice.

Complaints

Complaints about this notice or about how we handle your health information should be submitted in writing.  Delta Dental will not retaliate against you in any way for filing a complaint.  If you believe your privacy rights have been violated, you may file a complaint with the Secretary of the Department of Health and Human Services.

Send All Written Requests Regarding This Privacy Notice to: