Privacy Notice

Get copies of your health records

You have the right to inspect and obtain a copy of the information that we maintain about you in your designated record set (“health records”). Your health records typically include claim and payment information. Your right to this information does not include copies of information: 

• Made in reasonable anticipation of (or use in) a civil, criminal, or administrative action or proceeding;
• Subject to federal or state laws that do not allow us to give it to you;
• That could possibly harm you or another person. If we limit access because of this, you have the right to ask for a review of this decision.

A request to inspect and copy these records should be made in writing to the Compliance Department at the address listed below.  

We will provide a copy or  summary of your health records, usually within 30 days of your request, and we may charge a reasonable, cost-based fee. 

Correct health and claims records 

You can ask us to correct your health and claims records if you think they are incorrect or incomplete.

To request an amendment, your request must be made in writing and include a reason supporting the requested change. Please submit the request to the Compliance Department at the address listed below.

We may deny your request for an amendment if it is not in writing or does not include a reason. We may also deny your request for amending your health information if it covers health records that: 

• were not created by us, unless the person who actually created the information is no longer available to make the amendment;
• are not part of the information which you would be permitted to inspect and copy;
• are not part of the health records kept by or for us; or
• are accurate and complete.

We are not required to amend your PHI, but if we deny your request, we will provide you with information about our denial and how you can contest the denial. 

Request confidential communications

• If you're concerned about your safety, you can ask us to contact you in a specific way (for example, home or office phone number) or send mail to a different address.
• We will consider all reasonable requests and will agree if not doing so could put you in danger.

Request limits on how we share your information

• You have the right to ask us to limit how we use or share your information for payment or health care operations, especially for services paid in full out-of-pocket without using plan benefits.
• You have the right to request us to limit information that we may release to someone who is involved in your care or the payment for your care.
• We are not required to agree to your request. For example, we may deny a request if it could affect your care.
• To request restrictions, you must make your request in writing to the Compliance Department at the address listed below. In your written request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply (for example, disclosures to your spouse). 

Get a list of who we’ve shared your information with 

• You can ask for a list (accounting) of the times we’ve shared your health information for up to six years prior to the date of your request, who we shared it with, and why.
• This list won't include information shared for treatment, payment,  health care operations, or any other disclosures you asked us to make.
• We’ll provide one accounting per year for free. If you request more than one within 12 months, we will charge a reasonable, cost-based fee. 

Get a paper copy of this Notice 

• You can ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically. We will provide you with a paper copy promptly.
• You may also obtain a copy of the current version of the Notice of Privacy Practice and Rights of the Company at its website: www.deltadentalil.com 

Choose someone to act for you

• If you have given someone power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will ask the person to show proof of this authority to act for you before we take any action.

In these situations, you can choose to tell us to: 

• Share information with your family, close friends, or others involved in payment for your care
• Share information in a disaster relief situation

In these cases, we won’t share your information unless you give us written permission: 

• Marketing purposes
• Sale of your information

Payment for your health services 

• We might use or share your health information to get payment for your treatment.

Examples:

• Checking if you qualify for benefits.
• Billing for your treatment.
• Handling your health claims.
• Making decisions about your coverage.
• Managing your benefits.
• Coordinating payments for your benefits.

To assist in managing the care you receive 

• We might use or share your health information to help dentists and other medical providers treat you. 

Example: We might share information about your past treatment with a dentist if it affects your current treatment coverage. 

To run our organization 

• We might use or share your health information for our health care operations and contact you when necessary. We may share non-health information with other Delta Dental member companies for business operational purposes.
• We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage.

Examples: We use health information about you to develop better services. This may include:

• Conducting quality assessment and improvement activities.
• Training, licensing, or credentialing activities
• Setting rates.
• Conducting or arranging for treatment review.
• Legal services and audit functions, including fraud and abuse detection and compliance programs.
• Resolving grievances and other activities related to coverage determinations.
• Carrying out a wellness program. 

With Your Employer 

• If you are part of a group benefit program, your health information might be shared with the plan sponsor, usually your employer, to manage your benefits. We will only share this information if the sponsor has agreed to protect its confidentiality.
• In certain situations, we may share health information with the sponsor even without a confidentiality agreement. 

Examples of situations where a promise is not required:

• We can share summary health information to get premium bids or to change the group health plan. This summary information doesn't include details that can identify you.
• We can share information about whether you have joined or left your benefit program. 

With Business Associates

• We might hire people or companies called Business Associates to do different tasks or provide certain services for the Company.
• To do these tasks or provide these services, Business Associates might receive, create, maintain, use, or share your health information.
• Business Associates are permitted to use your health information only if they have entered into a written agreement with the Company to ensure its security and confidentiality.

Example: We might hire a company to handle billing or manage our data.

For health-related benefits

• We may use or disclose health information about you to communicate to you about health-related benefits and services.

Example: We may communicate to you about health-related benefits and services that add value to, but are not part of, your health plan.

To 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 

For research

• We can use or share your information for certain health research. 

To 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. 

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. 

• We can share health information about you with organ procurement organizations.
• We can share health information with a coroner, medical examiner, or funeral director when a person dies. 

To 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

To 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. 

For situations involving fraud

• We might report your health information if we suspect fraud.
• For example, we might share it with state and federal agencies that oversee us or your providers. These agencies include the U.S. Department of Health and Human Services, the Illinois Department of Insurance, or the Illinois Department of Financial and Professional Regulation.