ACMG, Inc. Notice of Privacy Practices
Effective April 14, 2003

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.

Introduction

In order to process claims related to your medical services, ACMG, Inc., ACMG of Kentucky and ACMG of South Carolina (hereinafter referred to as ACMG) must obtain and maintain protected health information about you. The Notice of Privacy Practices describes the types of information that is collected and your rights with regards to that information.

“Protected health information” means information that is individually identifiable as to the current patient or applicant for health care treatment, payment or operations. This information is obtained from applications for health care coverage, surveys, claims for payment filed by health care providers, referrals made by health care providers, and your medical records. Personal health information may also be obtained over the telephone from you. Other sources protected health information may be obtained from include group health plan administrators, employers, other insurance carriers and business partners such as consultants and other entities engaged in obtaining health care information.

Protected health information” includes the following:
  • Your health history
  • Your medical records
  • Your name, address, and date of birth
  • Your marital status
  • Sex
  • Social Security number
  • Information regarding your dependents
  • Other similar information that relates to past, present or future medical care
As a condition of enrollment into your Group Health Plan, ACMG will provide you with a copy of the Privacy Policy used by their operation relating to their practices to obtain, use, and the disclosure of your protected health information for the purpose of routine treatment, payment, and health care operations. These routine treatment, payment, and health care operations include:

  • Coordination of benefits
  • Enrollment into the group health plan
  • Eligibility for coverage issues
  • Claims administration
  • Processing of claims
  • Case Management and Utilization Review
  • Premium billing
  • Insurance underwriting
  • Business planning and development
  • Actuarial information
  • Complaint review
  • Regulatory review and legal compliance
Use and disclosures for treatment: Your protected health information may be disclosed to health care providers including doctors, nurses, laboratory technicians, medical students and other health care personnel involved in your treatment

Uses and disclosures for payment: Your protected health information may be disclosed to individuals involved in payment for your treatment in order to determine eligibility for payment and eligibility for plan benefits. Your protected health information may be shared with persons involved in utilization review, to assist in subrogation of health care claims, or other adjudication procedures.

Uses and disclosures for health care operations: Your protected health information may be used and disclosed for plan operation purposes including underwriting, premium rating, submitting claims for stop-loss coverage, quality review assessments, audits, business planning, legal services, or administrative services.

ACMG may share this information with its business associates including for purposes of utilization reviews, appropriateness of care reviews, consultation with outside health care providers, consultants, and attorneys. ACMG requires its business associates to sign a contract specifying their compliance with the privacy policy of ACMG on behalf of your Plan Sponsor.

In order to ensure the privacy of your protected health information, ACMG has developed privacy policies and procedures in accordance with the HIPAA Privacy Laws. Procedures are based on appropriate administrative, technical and physical safeguards necessary to maintain confidentiality of your protected health information. Such information is limited to those individuals that have a legitimate business need for that information. This protection extends to use of your protected health information by ACMG business associates.

Non-routine disclosures of personal health information
In situations not covered by your consent, ACMG will ask for your authorization to use or disclose your protected health information. ACMG will use or disclose information in these circumstances pursuant to the specific purpose contained in your authorization and will only use or disclosure the minimum amount of information necessary to perform the non-routine function. In most circumstance, authorization may only be made by the person to which the protected health information pertains. In some circumstances, authorization may be obtained from a person representing your interests such as in emergency situations where authorization would be impractical to obtain or in the case of minor dependents.

Non-routine disclosures may be made to:
  • Requests of medical records pertaining to specialized care when required by the plan
  • Organ donation and tissue transplant entities, if you are an organ or tissue donor
  • Department of Defense Health Care Program if you are a member of the armed services
  • Workers’ compensation carriers
  • Public health agencies
  • Law enforcement personnel in response to legal requirements
  • Coroners, medical examiners, funeral directors
  • Legal representative in response to a court order or other legal proceeding
  • National security and intelligence agencies as authorized by law
  • Correctional institutions if you are an inmate
Your rights
You have the right to review your protected health information maintained by ACMG, Inc. and to obtain a copy of such information.

You also have the right to request amendments to your protected health information or to register a complaint with the ACMG Privacy Officer. Request for amendments must be made in writing and must include a reason for the requested amendment.

You have a right to request an accounting of disclosures of your protected health information made by ACMG. This request must be made in writing and may not be for a period longer than six years or for a full accounting prior to April 14, 2003.

You have a right to request a restriction on your protected health information that may be disclosed. ACMG, Inc. will accommodate all reasonable requests.

All requests should be sent to ACMG, Attn: Paul McVay – Privacy Officer, 2570 Miamisburg, OH 45342.

Changes to Privacy Practices
Changes to Privacy Practices If ACMG changes its privacy policies and procedures, an updated Notice of Privacy Practices will be provided. Up-to-date privacy notices are maintained on the ACMG web site at www.ACMG-INC.com.