STATE HEALTH BENEFITS PROGRAM and
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM
PRIVACY PRACTICES

The federal Health Insurance Portability and Accountability Act (HIPAA) requires health plans to maintain the privacy of any personal information relating to its members' physical or mental health. The State Health Benefits Program (SHBP) and the School Employees' Health Benefits Program (SEHBP) provide the following information, in compliance with HIPAA, about the safeguarding of your medical information. Scroll down this page or click on the links below to view the SHBP/SEHBP Notice of Privacy Practices or to download related forms.

• Notice of Privacy Practices to Enrollees — The SHBP's and SEHBP's policy on authorized access to and the protection of personal medical information.
  
  
• Downloadable Privacy Forms for SHBP/SEHBP Enrollees — Forms enrollees may use to authorize, restrict, or review personal medical information maintained by the SHBP and SEHBP.

NOTICE OF PRIVACY PRACTICES TO ENROLLEES IN THE
STATE HEALTH BENEFITS PROGRAM AND
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM

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 DATE: APRIL 30, 2013

Download this Privacy Notice Adobe PDF (34K)

Protected Health Information

The State Health Benefits Program (SHBP) and School Employees" Health Benefits Program (SEHBP) are required by the federal Health Insurance Portability and Accountability Act (HIPAA) and State laws to maintain the privacy of any information that is created or maintained by the Programs that relates to your past, present, or future physical or mental health. This Protected Health Information (PHI) includes information communicated or maintained in any form. Examples of PHI are your name, address, Social Security number, birth date, telephone number, fax number, dates of health care service, diagnosis codes, and procedure codes. PHI is collected by the Programs through various sources, such as enrollment forms, employers, health care providers, federal and State agencies, or third-party vendors.

The Programs are required by law to abide by the terms of this Notice. The Programs reserve the right to change the terms of this Notice. If the Programs make material change to this Notice, a revised Notice will be sent.

Uses and Disclosures of PHI

The Programs are permitted to use and to disclose PHI in order for our members to obtain payment for health care services and to conduct the administrative activities needed to run the Programs without specific member authorization. Under limited circumstances, we may be able to provide PHI for the health care operations of providers and health plans. Specific examples of the ways in which PHI may be used and disclosed are provided below. This list is illustrative only and not every use and disclosure in a category is listed.

• The Programs may disclose PHI to a doctor or a hospital to assist them in providing a member with treatment.
  
  
• The Programs may use and disclose member PHI so that our Business Associates may pay claims from doctors, hospitals, and other providers.
  
  
• The Programs receive PHI from employers, including a member's name, address, Social Security number, and birth date. This enrollment information is provided to our Business Associates so that they may provide coverage for health care benefits to eligible members.
  
  
• The Programs and/or our Business Associates may use and disclose PHI to investigate a complaint or process an appeal by a member.
  
  
• The Programs may provide PHI to a provider, a health care facility, or a health plan that is not our Business Associate that contacts us with questions regarding the member's health care coverage.
  
  
• The Programs may use PHI to bill the member for the appropriate premiums and reconcile billings we receive from our Business Associates.
  
  
• The Programs may use and disclose PHI for fraud and abuse detection.
  
  
• The Programs may allow use of PHI by our Business Associates to identify and contact our members for activities relating to improving health or reducing health care costs, such as information about disease management programs or about health-related benefits and services or about treatment alternatives that may be of interest to them.
  
  
• In the event that a member is involved in a lawsuit or other judicial proceeding, the Programs may use and disclose PHI in response to a court or administrative order as provided by law.
  
  
• The Programs may use or disclose PHI to help evaluate the performance of our health plans. Any such disclosure would include restrictions for any other use of the information other than for the intended purpose.
  
  
• The Programs may use PHI in order to conduct an analysis of our claims data. This information may be shared with internal departments such as auditing or it may be shared with our Business Associates, such as our actuaries.

Except as described above, unless a member specifically authorizes us to do so, the Programs will provide access to PHI only to the member, the member's authorized representative, and those organizations who need the information to aid the Program in the conduct of its business (our "Business Associates"). An authorization form Adobe PDF (39K) may be obtained over the Internet at: www.state.nj.us/treasury/pensions or by sending an e-mail to: hipaaform@treas.state.nj.us   A member may revoke an authorization at any time.

Restricted Uses

• PHI that contains genetic information is prohibited from use or disclosure by the Programs for underwriting purposes.

• The use or disclosure of PHI that includes psychotherapy notes requires authorization from the member.

When using or disclosing PHI, the Programs will make every reasonable effort to limit the use or disclosure of that information to the minimum extent necessary to accomplish the intended purpose. The Programs maintain physical, technical, and procedural safeguards that comply with federal law regarding PHI. In the event of a breach of unsecured PHI the member will be notified.

Member Rights

Members of the Programs have the following rights regarding their PHI:

Right to Inspect and Copy: With limited exceptions, members have the right to inspect and/or obtain a copy of their PHI that the Programs maintain in a designated record set which consists of all documentation relating to member enrollment and the Program's use of this PHI for claims resolution. The member must make a request in writing to obtain access to their PHI. The member may use the contact information found at the end of this Notice to obtain a form to request access.

Right to Amend: Members have the right to request that the Programs amend the PHI that we have created and that is maintained in our designated record set.

We cannot amend demographic information, treatment records or any other information created by others. If members would like to amend any of their demographic information, please contact your personnel office. To amend treatment records, a member must contact the treating physician, facility, or other provider that created and/or maintains these records.

The Programs may deny the member's request if: 1) we did not create the information requested on the amendment; 2) the information is not part of the designated record set maintained by the Programs; 3) the member does not have access rights to the information; or 4) we believe the information is accurate and complete. If we deny the member's request, we will provide a written explanation for the denial and the member's rights regarding the denial.

Right to an Accounting of Disclosures: Members have the right to receive an accounting of the instances in which the Programs or our Business Associates have disclosed member PHI. The accounting will review disclosures made over the past six years. We will provide the member with the date on which we made a disclosure, the name of the person or entity to whom we disclosed the PHI, a description of the information we disclosed, the reason for the disclosure, and certain other information. Certain disclosures are exempted from this requirement (e.g., those made for treatment, payment or health benefits operation purposes or made in accordance with an authorization) and will not appear on the accounting.

Right to Request Restrictions: The member has the right to request that the Programs place restrictions on the use or disclosure of their PHI for treatment, payment, or health care operations purposes. The Programs are not required to agree to any restrictions and in some cases will be prohibited from agreeing to them. However, if we do agree to a restriction, our agreement will always be in writing and signed by the Privacy Officer. The member request for restrictions must be in writing. A form can be obtained by using the contact information found at the end of this Notice.

Right to Restrict Disclosure: The member has the right to request that a provider restrict disclosure of PHI to the Programs or Business Associates if the PHI relates to services or a health care item for which the individual has paid the provider in full. If payment involves a flexible spending account or health savings account, the individual cannot restrict disclosure of information necessaryto make the payment but may request that disclosure not be made to another program or health plan.

Right to Receive Notification of a Breach: The member has the right to receive notification in the event that the Programs or a Business Associate discover unauthorized access or release of PHI through a security breach.

Right to Request Confidential Communications: The member has the right to request that the Programs communicate with them in confidence about their PHI by using alternative means or an alternative location if the disclosure of all or part of that information to another person could endanger them. We will accommodate such a request if it is reasonable, if the request specifies the alternative means or locations, and if it continues to permit the Programs to collect premiums and pay claims under the health plan.

To request changes to confidential communications, the member must make their request in writing, and must clearly state that the information could endanger them if it is not communicated in confidence as they requested.

Right to Receive a Paper Copy of the Notice: Members are entitled to receive a paper copy of this Notice. Please contact us using the information at the end of this Notice or click this link to download this Privacy Notice. Adobe PDF (34K)

Questions and Complaints

If you have questions or concerns, please contact the Programs using the information listed at the end of this Notice.

If members think the Programs may have violated their privacy rights, or they disagree with a decision made about access to their PHI, in response to a request made to amend or restrict the use or disclosure of their information, or to have the Programs communicate with them in confidence by alternative means or at an alternative location, they must submit their complaint in writing. To obtain a form for submitting a complaint, use the contact information found at the end of this Notice.

Members also may submit a written complaint to the U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201.

The Programs support member rights to protect the privacy of PHI. It is your right to file a complaint with the Programs or with the U.S. Department of Health and Human Services.

Downloadable Privacy Forms for SHBP and SEHBP Enrollees

Please be advised that the only health information available from the Division of Pensions and Benefits consists of current eligibility, enrollment, and premium billing information, copies of enrollment applications and correspondence, and State Health Benefits Commission or School Employees' Health Benefits Program appeal records. If the information you are referencing is for a claim, payment of a claim, or medical records you must contact your medical or dental plan carrier or the office of your physician or dentist.

Member Authorization Form for Use and Disclosure of Protected and Private Information
Use this form to authorize the release of your personal information to providers and agencies that do not normally conduct business with the SHBP or SEHBP. Download form Adobe PDF (39K)

Request to Restrict the Release of Personal Information
Use this form to restrict to whom the SHBP or SEHBP may release your personal information. Download form Adobe PDF (73K)