Notice of Privacy Practices

Your privacy is important to us.

Effective: 10/1/2021

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.

We understand that health information about you is personal, and we are committed to protecting this information.We are required by law to:

  • Ensure that your health information is kept private
  • Give you this Notice of our legal duties and privacy practices about your health information
  • Notify you if your unsecured health information was breached
  • Follow the terms of the Notice that is currently in effect

How we collect and protect information

We collect information from forms when you apply or enroll. This information includes your name, address, Social Security Number, general health status information, employment, and other information needed for coverage. We also collect information from healthcare coverage transactions with ApexHealth and our business associates. This includes information such as claims, service authorization requests, deductible payments, and copayments. We may gather information in writing, in person, by telephone, or electronically.

We keep your information secure through physical, technical, and procedural safeguards. All information collected is treated in a confidential and secure manner whether you are a prospective, current, or former member.

How we use or share information

We typically use or share your health information for the following purposes:

  • For treatment: We share your health information with doctors, hospitals, and others in order to get you the care you need
  • For payment: We use your health information to pay doctors, hospitals, and others who have provided you medical care. We may also forward bills to other health plans or organizations for payment
  • For healthcare operations: We may use your health information to check the quality of care you receive. We may also use this information in audits, programs to stop fraud and abuse, financial and organizational planning, and general administration

Providing healthcare information where it’s needed

We may use information about you for the following reasons:

  • To share alternative medical treatments and programs, or health-related products and services you may be interested in. For example, we may send newsletters to let you know about healthy living alternatives, such as smoking cessation or weight loss programs

We may share your information for the following reasons:

  • With a family member or friend as needed to help with your healthcare or with payment for your healthcare. For example, you may not be able to authorize care or payment due to a medical emergency
  • With authorized private or public entities to help with disaster relief
  • With other people or companies who perform business functions for us. For example, we may share your information with a company that does data entry for us

We may be allowed or required to share your health information in other ways, such as public health and research. We must meet many conditions in the law before we can share your information for the following purposes (for more information see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html):

  • To support your care: We may share your health information with your family or friends if you are unable to communicate in an emergency
  • To help with public health and safety issues: We may share health information about you for certain situations, including preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety
  • To do research: We may use or share your information for health research
  • To comply with the law: We may 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’re complying with federal privacy law
  • To respond to organ and tissue donation requests and work with a medical examiner or funeral director: We may share health information about you with organ procurement organizations and with a coroner, medical examiner, or funeral director when an individual dies
  • To address workers’ compensation, law enforcement, and other government requests: We may 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 under law; for special government functions such as military, national security, and presidential protective services
  • To respond to lawsuits and legal actions: We may share health information about you in response to a court or administrative order, or in response to a subpoena
  • To individuals involved in your care: We may share information with people involved in your healthcare, or with your personal representative

If we want to use or disclose your health information for any purpose not listed above, we must first get your written permission. If you give us your written permission, you may take it back in writing at any time. Examples of when your authorization is required include, but are not limited to most uses and disclosure of psychotherapy notes; uses and disclosures of your information for marketing purposes; and disclosures that would mean the sale of your information.

About your rights

Your rights include the right to:

  • Ask us to limit what we use or share: You may ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request unless the disclosure is to carry out payment or healthcare operations and is not required by law, or the health information relates to a healthcare item or service for which we have been paid in full
  • Request confidential communications: You may ask us to contact you in a specific way (at your office, for example) or to send mail to a different address
  • Get a copy of health and claims records: You may ask to see or receive a copy of health and claims records and other health information we have about you. We may charge a reasonable fee for copying and postage
  • Ask us to correct health and claims records: You may ask us to correct your health and claims records if you think they are incorrect or incomplete. We may say “no” to your request, but we’ll tell you why in writing
  • Get a list of those with whom we’ve shared your information: You may ask for a list (accounting) of the times we’ve shared your health information for six year prior to the date you ask, who we shared it with, and why. We will include all disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months
  • Get a copy of this notice: You may ask us to provide a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
  • Be notified of a breach of your unsecured health information: You will notified if a breach results in your health information being inappropriately shared or used.
  • Choose someone to act for you:

Exercising your rights

To obtain the forms to exercise your rights contact Concierge Services at 844-279-0508 (TTY: 711). If you have any questions about this Notice or about how we use or disclose information, please contact the ApexHealth Privacy Officer at 844-279-0508, or by email at privacyofficer@apexhealth.com

If you believe your privacy rights have been violated, you may send a complaint to:

ApexHealth, Attn: Privacy Officer,96 Kercheval Avenue, Suite 200, Grosse Pointe Farms, MI 48236

You may also file a written complaint with the Department of Health and Human Services Office of Civil Rights. Visit www.hhs.gov/ocr to find the contact information. You may also contact our office for more specific information. We will not take any action against you for filing a complaint

Changes to this notice

The effective date of this notice is located at the top of this page. We reserve the right to change the terms of this notice and to make the new notice effective for all health information we maintain. If revised, we will notify you that a change has been made by mailing you a new Notice. You may also find the most recent Notice at www.apexhealth.com/notice-of-privacy-practice/