Privacy Policy

For help translating or understanding this notice, you may contact 1-877-324-7543.

Purpose: Driscoll Health Plan (DHP) is required by law to maintain the privacy of Protected Health Information (PHI). We are required to provide this notice of our legal duties and privacy practices regarding uses and disclosures of PHI as well as inform you regarding your individual rights. This notice explains the purposes for which we are permitted to use and disclose your PHI. 

The following categories describe different ways that we may use and disclose your PHI. Not every potential use and disclosure in a category will be listed. 

For Treatment. We are permitted to use and disclose your PHI to a physician or health care provider who is involved in your care or provides you with medical treatment or services. This may include, but is not limited to, the use and disclosure of your PHI to assist with prior authorization decisions related to your benefits. 

For Payment. We are permitted to use and disclose your PHI to obtain payment for your health care treatment or services. This may include, but is not limited to, certain activities such as processing claims, determining eligibility or coverage for benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. 

For Healthcare Operations. We are permitted to use and disclose your PHI for our business operations. This may include, but is not limited to, quality assessment activities, investigating complaints and appeals, and providing case management and care coordination. 

To Business Associates for Treatment, Payment, and Healthcare Operations. We are permitted to disclose your PHI to our business associates to carry out treatment, payment, or healthcare operations. Business associates are also required to protect your PHI. 

Individuals Involved in Your Care or Payment for Your Care. We may release your PHI to a family member, other relative, close personal friend or designated personal representative who is involved in your medical care if the PHI released is directly relevant to the person’s involvement with your care. We may also release information to someone who helps pay for your care. 

Appointment Reminders, Treatment Alternatives and Health Related Services. We may use and disclose your PHI to contact you to remind you of an appointment or to provide you with information about treatment options or alternatives, and health care-related benefits or services that may be of interest to you. 

Marketing Activities. We may use certain information, such as name, address, or telephone number to contact you in the future to request permission to share your story with the community in official marketing for DHP. You have the right to opt-out if you do not want to be contacted. To do so, please notify us in writing specifying your preferences with regards to being contacted for marketing activities. 

As Required by Law. We will disclose your PHI when required to do so by federal, state, or local law. 

Public Health Activities. We may disclose your PHI for public health activities. This may include, but is not limited to, (1) preventing or controlling disease, injury, or disability; (2) reporting child abuse or neglect; or (3) notifying the appropriate government authority if we believe a member has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law. 

Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized by law such as audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws. This may include, but is not limited to, audits and investigations necessary for oversight of government benefit programs. 

Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested. 

Law Enforcement. We may release PHI if asked to do so by a law enforcement official: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) to identify or locate a suspect, fugitive, material witness or missing person—but only if limited information is disclosed; (3) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct we believe occurred on DHP’s premises; and (6) in emergency circumstances to report a crime or to determine the location of the crime, its victims, or the identity, description or location of the person who committed the crime. 

Coroners, Medical Examiners and Funeral Directors. We may release PHI about you to a coroner or medical examiner to identify a deceased person or to determine the cause of death. We may also release PHI to funeral directors as necessary to help them carry out their duties. 

Organ and Tissue Donation. We may release PHI to organizations that handle organ procurement; or organ, eye, or tissue transplantation; or to an organ donation bank to facilitate organ or tissue donation and transplantation. 

Research. Under certain circumstances, we may use and disclose your PHI for research purposes. Before we use or disclose PHI for research, the research project will have been approved through an Institutional Review Board. Pre-approval may not be required when researchers are preparing a research project and need to look at information about members with specific medical needs, so long as the PHI does not leave DHP. 

To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. This may include, but is not limited to, disclosure to law enforcement if the information is needed to identify or apprehend an escapee or violent criminal. 

To Authorized Governmental Authorities and Military Officials. We may disclose PHI regarding members of the armed forces or to authorized federal authorities for official investigations, intelligence, counterintelligence, or other national security activities. 

To Authorized Governmental Programs Providing Public Benefits. We may disclose PHI regarding your eligibility for or enrollment in DHP to another agency administering a government program providing public benefits as authorized or required by law. 

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your PHI to the correctional institution or law enforcement official under specific circumstances. 

Workers’ Compensation. We may release your PHI for workers’ compensation or similar programs. 

Disclosures Requiring an Authorization. Other uses and disclosures will be made only with a valid authorization. Except in certain circumstances, we must obtain an authorization for any use or disclosure of PHI for marketing, psychotherapy notes or sale of PHI. 

You have the following rights regarding the PHI we maintain about you. For questions regarding how to exercise your rights, please utilize the contact information at the end of this notice. 

Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or healthcare operations. We are not required to agree to or abide by your request. If we do agree, we will comply with your request unless the information is required to provide you with emergency treatment, or the agreement has been terminated in accordance with HIPAA guidelines. Requests must be received in writing. 

Right to Restrict Disclosures to Health Plans. We will agree to your request to restrict the use or disclosure of PHI for payment or health care operations to a health plan for a service or item for which you, or someone other than the health plan, has paid the health care provider in full. 

Right to Request Confidential Communications. You have the right to request that we communicate with you about your PHI in a certain way or at a certain location. For example, you can ask that we only contact you by telephone at work or that we only contact you by mail at home. Your request must specify how, where or when you wish to be contacted. This right only applies if you clearly state that the disclosure of all or part of your PHI could endanger you if not communicated by the alternative means or location requested. 

Right to Inspect and Receive a Copy. You have the right to request access to inspect, receive a physical or electronic copy, or be provided a summary of your PHI contained in a designated record set. We may deny your request in certain limited circumstances. For example, psychotherapy notes are prohibited from being inspected or copied. We may charge a fee for the costs of copying, mailing or other supplies associated with your request. We are required to notify you in advance regarding these charges. If your request is denied we will notify you, and you may request that the denial be reviewed. Another licensed healthcare professional, chosen by DHP, will perform a secondary review. The review will not be conducted by any healthcare professional involved in the denial of your original request. We will comply with the outcome of the review to the extent allowable by law. 

Right to Amend. If you believe that information we have about you is incorrect or incomplete, you may request an amendment. You have the right to request an amendment for as long as the information is kept by or for DHP. You must include a reason that supports your request. All requests for amendment should be made in writing. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (2) is not part of the PHI kept by or for DHP; (3) is not part of the information that you would be permitted to inspect and copy; or (4) is accurate and complete. DHP will notify you if we deny the request and will include instructions as to how you may appeal the request or file a complaint. 

Right to be Notified. You have a right to be notified regarding an unlawful breach of unsecured PHI. 

Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures related to certain disclosures regarding your PHI. We may charge you a reasonable fee if you request a disclosure more than once each year. 

Information Maintained in Paper Records. You may request a record of disclosures that have been made to persons or entities other than for treatment, payment or healthcare operations that have taken place in the past six (6) years. 

Information Maintained Electronically. Subject to a schedule established by federal law, if we maintain your PHI electronically, you have the right to ask for an accounting of all disclosures. Under federal law, you may request an accounting for a period of three (3) years prior to the date the accounting is requested. 

Right to a Copy of This Notice. You have the right to a paper copy of this notice at any time. You may also obtain an electronic copy of this notice by clicking on Notice of Privacy Practices (NOPP) located on DHP’s web site at www.driscollhealthplan.com. 

Right to Revoke Authorization. You have a right to revoke a previous authorization you have made for uses and disclosures at any time, provided that the revocation is submitted in writing. The revocation will be in effect upon receipt and validation with the exception and to the extent that the entity has previously used or disclosed PHI in reliance on a previous authorization. 

We reserve the right to change or revise this notice at any time. The new notice will contain the effective date. DHP reserves the right to apply the amended notice to all previously acquired PHI about you. As part of your annual mailing, you will receive a copy of the current notice in effect. 

Complaints: If you believe your privacy rights have been violated, you may file a complaint utilizing the contact information at the end of this notice, or by contacting the U.S. Department of Health and Human Services at 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201, Phone: 1-800-368-1019, or Email: OCRComplaint@hhs.gov. You will not be penalized for filing a complaint. 

Driscoll Health System, Chief Privacy Officer 

4525 Ayers Street 

Corpus Christi, Texas 78415 

Office Phone: 1-877-324-7543