Notice of Privacy Practices
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.
Effective August 22, 2016
We are required by law to protect the privacy of your health information. We are also required to
send you this notice, which explains how we may use information about you and when we can
give out or "disclose" that information to others. You also have rights regarding your health
information that are described in this notice. We are required by law to abide by the terms of this
The terms "information" or "health information" in this notice includes any information we
maintain that reasonably can be used to identify you and that relates to your physical or mental
health condition, the provision of health care to you, or the payment for such health care. We
will comply with the requirements of applicable privacy laws related to notifying you in the
event of a breach of your health information.
We have the right to change our privacy practices and the terms of this notice. If we make a
material change to our privacy practices, we will provide to you, in our next annual distribution,
either a revised notice or information about the material change and how to obtain a revised
notice. We will provide you with this information either by direct mail or electronically, in
accordance with applicable law. In all cases, we will post the revised notice on our
website, PacificSource.com. We reserve the right to make any revised or
changed notice effective for information we already have and for information that we receive in
PacificSource collects and maintains oral, written and electronic information to administer our
business and to provide products, services and information of importance to our enrollees. We
maintain physical, electronic and procedural security safeguards in the handling and maintenance
of our enrollees’ information, in accordance with applicable state and federal standards, to
protect against risks such as loss, destruction or misuse.
How We Use or Disclose Information
We must use and disclose your health information to provide that information:
To you or someone who has the legal right to act for you (your personal representative) in
order to administer your rights as described in this notice; and
To the Secretary of the Department of Health and Human Services, if necessary, to make
sure your privacy is protected.
We have the right to use and disclose health information for your treatment, to pay for your
health care and to operate our business. For example, we may use or disclose your health
For Payment of premiums due to us, to determine your coverage, and to process claims for
health care services you receive, including for subrogation or coordination of other benefits
you may have. For example, we may tell a doctor whether you are eligible for coverage and
what percentage of the bill may be covered.
For Treatment. We may use or disclose health information to aid in your treatment or the
coordination of your care. For example, we may disclose information to your physicians or
hospitals to help them provide medical care to you.
For Health Care Operations. We may use or disclose health information as necessary to
operate and manage our business activities related to providing and managing your health
care coverage. For example, we might talk to your physician to suggest a disease
management or wellness program that could help improve your health or we may analyze
data to determine how we can improve our services.
To Provide You Information on Health Related Programs or Products such as alternative
medical treatments and programs or about health-related products and services, subject to
limits imposed by law.
For Plan Sponsors. If your coverage is through an employer sponsored group health plan,
we may share summary health information and enrollment and disenrollment information
with the plan sponsor. In addition, we may share other health information with the plan
sponsor for plan administration purposes if the plan sponsor agrees to special restrictions on
its use and disclosure of the information in accordance with federal law.
For Underwriting Purposes. We may use or disclose your health information for
underwriting purposes; however, we will not use or disclose your genetic information for
For Reminders. We may use or disclose health information to send you reminders about
your benefits or care, such as appointment reminders with providers who provide medical
care to you.
We may use or disclose your health information for the following purposes under limited
- As Required by Law. We may disclose information when required to do so by law.
To Persons Involved With Your Care. We may use or disclose your health information to a
person involved in your care or who helps pay for your care, such as a family member,
when you are incapacitated or in an emergency, or when you agree or fail to object when
given the opportunity. If you are unavailable or unable to object, we will use our best
judgment to decide if the disclosure is in your best interests. Special rules apply regarding
when we may disclose health information to family members and others involved in a
deceased individual’s care. We may disclose health information to any persons involved,
prior to the death, in the care or payment for care of a deceased individual, unless we are
aware that doing so would be inconsistent with a preference previously expressed by the
For Public Health Activities such as reporting or preventing disease outbreaks to a public
For Reporting Victims of Abuse, Neglect or Domestic Violence to government authorities
that are authorized by law to receive such information, including a social service or
protective service agency.
For Health Oversight Activities to a health oversight agency for activities authorized by
law, such as licensure, governmental audits and fraud and abuse investigations.
For Judicial or Administrative Proceedings such as in response to a court order, search
warrant or subpoena.
For Law Enforcement Purposes. We may disclose your health information to a law
enforcement official for purposes such as providing limited information to locate a missing
person or report a crime.
To Avoid a Serious Threat to Health or Safety to you, another person, or the public, by, for
example, disclosing information to public health agencies or law enforcement authorities, or
in the event of an emergency or natural disaster.
For Specialized Government Functions such as military and veteran activities, national
security and intelligence activities, and the protective services for the President and others.
For Workers’ Compensation as authorized by, or to the extent necessary to comply with,
state workers compensation laws that govern job-related injuries or illness.
For Research Purposes such as research related to the evaluation of certain treatments or the
prevention of disease or disability, if the research study meets federal privacy law
To Provide Information Regarding Decedents. We may disclose information to a coroner
or medical examiner to identify a deceased person, determine a cause of death, or as
authorized by law. We may also disclose information to funeral directors as necessary to
carry out their duties.
For Organ Procurement Purposes. We may use or disclose information to entities that
handle procurement, banking or transplantation of organs, eyes or tissue to facilitate
donation and transplantation.
To Correctional Institutions or Law Enforcement Officials if you are an inmate of a
correctional institution or under the custody of a law enforcement official, but only 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) for the safety and security of the
To Business Associates that perform functions on our behalf or provide us with services if
the information is necessary for such functions or services. Our business associates are
required, under contract with us and pursuant to federal law, to protect the privacy of your
information and are not allowed to use or disclose any information other than as specified in
our contract and as permitted by federal law.
Additional Restrictions on Use and Disclosure. Certain federal and state laws may require
special privacy protections that restrict the use and disclosure of certain health information,
including highly confidential information about you. “Highly confidential information” may
include confidential information under Federal laws governing alcohol and drug abuse
information and genetic information as well as state laws that often protect the following
types of information:
- Mental health;
- Genetic tests;
- Alcohol and drug abuse;
- Sexually transmitted diseases and reproductive health information; and
- Child or adult abuse or neglect, including sexual assault.
If a use or disclosure of health information described above in this notice is prohibited or
materially limited by other laws that apply to us, it is our intent to meet the requirements of the
more stringent law.
Except for uses and disclosures described and limited as set forth in this notice, we will use and
disclose your health information only with a written authorization from you. This includes,
except for limited circumstances allowed by federal privacy law, not using or disclosing
psychotherapy notes about you, selling your health information to others, or using or disclosing
your health information for certain promotional communications that are prohibited marketing
communications under federal law, without your written authorization. Once you give us
authorization to release your health information, we cannot guarantee that the recipient to whom
the information is provided will not disclose the information. You may take back or "revoke"
your written authorization at any time in writing, except if we have already acted based on your
authorization. To find out where to mail your written authorization and how to revoke an
authorization, contact the Customer Service phone number listed on your ID card.
What Are Your Rights
The following are your rights with respect to your health information:
You have the right to ask to restrict uses or disclosures of your information for treatment,
payment, or health care operations. You also have the right to ask to restrict disclosures to
family members or to others who are involved in your health care or payment for your
health care. We may also have policies on dependent access that authorize your dependents
to request certain restrictions. Please note that while we will try to honor your request and
will permit requests consistent with our policies, we are not required to agree to any
You have the right to ask to receive confidential communications of information in a
different manner or at a different place (for example, by sending information to a P.O. Box
instead of your home address). We will accommodate reasonable requests where a
disclosure of all or part of your health information otherwise could endanger you. In certain
circumstances, we will accept your verbal request to receive confidential communications,
however, we may also require you confirm your request in writing. In addition, any requests
to modify or cancel a previous confidential communication request must be made in
writing. Mail your request to the address listed below.
You have the right to see and obtain a copy of certain health information we maintain about
you such as claims and case or medical management records. If we maintain your health
information electronically, you will have the right to request that we send a copy of your
health information in an electronic format to you. You can also request that we provide a
copy of your information to a third party that you identify. In some cases you may receive a
summary of this health information. You must make a written request to inspect and copy
your health information or have your information sent to a third party. Mail your request to
the address listed below. In certain limited circumstances, we may deny your request to
inspect and copy your health information. If we deny your request, you may have the right
to have the denial reviewed. We may charge a reasonable fee for any copies.
You have the right to ask to amend certain health information we maintain about you such
as claims and case or medical management records, if you believe the health information
about you is wrong or incomplete. Your request must be in writing and provide the reasons
for the requested amendment. Mail your request to the address listed below. If we deny
your request, you may have a statement of your disagreement added to your health
You have the right to receive an accounting of certain disclosures of your information made
by us during the six years prior to your request. This accounting will not include disclosures
of information made: (i) for treatment, payment, and health care operations purposes; (ii) to
you or pursuant to your authorization; and (iii) to correctional institutions or law
enforcement officials; and (iv) other disclosures for which federal law does not require us to
provide an accounting.
You have the right to a paper copy of this notice. You may ask for a copy of this notice at
any time. Even if you have agreed to receive this notice electronically, you are still entitled
to a paper copy of this notice.You may also obtain a copy of this notice on our
Exercising Your Rights
Contacting your Health Plan. If you have any questions about this notice or want
information about exercising your rights, please
call the toll-free member phone number on
your health plan ID card
or you may contact a PacificSource Customer Call Center
Representative at 888-863-3637, TTY 800-735-2900.
Submitting a Written Request. Mail to us your written requests to exercise any of your
rights, including modifying or cancelling a confidential communication, requesting copies
of your records, or requesting amendments to your record, at the following address:
PacificSource Customer Service
555 International Way
Springfield, OR 97477
Filing a Complaint. If you believe your privacy rights have been violated, you may file a
complaint with us at the address listed above.
You may also notify the Secretary of the U.S. Department of Health and Human Services of
We will not take any action against you for filing a complaint.
Website Privacy Information
Information Collection, Use, and Sharing
What personally identifiable information is collected from you through the web site, how
it is used and with whom it may be shared.
- What choices are available to you regarding the use of your data.
- The security procedures in place to protect the misuse of your information.
- How you can correct any inaccuracies in the information.
We are the sole owners of the information collected on this site. We only have access to/collect
information that you voluntarily give us via email or other direct contact from you. We will not sell or
rent this information to anyone.
We will use your information to respond to you, regarding the reason you contacted us. We will not share
your information with any third party outside of our organization, other than as necessary to fulfill your
request, e.g. to ship an order.
Unless you ask us not to, we may contact you via email in the future to tell you about specials, new
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improve your access to our site and identify repeat visitors to our site. For instance, when we use a cookie
to identify you, you would not have to log in a password more than once, thereby saving time while on
our site. Cookies can also enable us to track and target the interests of our users to enhance the experience
on our site. Usage of a cookie is in no way linked to any personally identifiable information on our site.