Notice of Privacy Practices For
Protected Health Information

NOTICE OF PRIVACY PRACTICES FOR
PROTECTED HEALTH INFORMATION

Section 1: Purpose of this Notice and Effective Date

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.

The Operating Engineers Health & Welfare Fund (the "Fund") understands that information about you and your health is personal. We are committed to protecting your health information.

This notice is required by law and will tell you about the ways in which we may use and disclose your health information. The Fund is required to take reasonable steps to ensure that personally identifiable health information about you is kept private and to inform you about:

• The Fund’s uses and disclosures of Protected Health Information (PHI),

• Your rights to privacy with respect to your PHI,

• The Fund’s duties with respect to your PHI,

• Your right to file a complaint with the Fund and with the Secretary of the United States Department of Health and Human Services (HHS), and

• The person or office you should contact for more information about the Fund’s privacy practices.

Section 2: Your Protected Health Information

“Protected Health Information” (PHI) includes all individually identifiable health information related to your past, present or future physical or mental health condition or the payment for your health care. PHI includes information maintained by the Fund in oral, written or electronic form.

When the Fund May Disclose Your PHI

Under the law, the Fund may disclose your PHI without your consent or authorization, or the opportunity to agree or object, in the following cases:

• At your request. We are required to give you access to certain health information when you request to inspect and copy it.

• As required by HHS. The Department of Health and Human Services may require the disclosure of your PHI to investigate or determine our compliance with the privacy regulations.

• For treatment, payment or health care operations. The Fund and its business associates (please see definition below in paragraph 4) will use your health information in a responsible manner without your consent, authorization, or opportunity to agree or object, to carry out treatment, payment, and health care operations. The Fund will also disclose your health information to the Board of Trustees for purposes related to treatment, payment, and health care operations. For example, we may disclose information to the Board of Trustees to allow them to decide your appeal or to review a subrogation claim. The Board of Trustees has amended its Plan documents to protect your health information as required by federal law.

When the Disclosure of Your PHI Requires Your Written Authorization

• Psychotherapy notes. Although the Fund does not routinely obtain psychotherapy notes, your written authorization will generally be obtained before the Fund will use or disclose psychotherapy notes about you. However, the Fund may use and disclose such notes when needed by the Fund to defend against litigation filed by you.

• To provide your PHI to the Pension Fund. If your health information is needed by the Pension Fund to help evaluate your disability pension application, your written authorization will be obtained before the Fund will disclose this information.

• To provide your PHI to your employer. Your written authorization will be obtained before the Fund discloses any of your PHI to your employer.

When We Must Give You the Opportunity to Agree or Disagree Before the Use or Disclosure

The Fund may disclose your PHI to immediate family members, other relatives, your close personal friends, and any other person you choose, who is involved in your health care or payment for that care, unless you are given the opportunity to object but do not object or you request a restriction (in accordance with the process described below under “You May Request Restriction on the Use and Disclosure of PHI”).

When Your Consent, Authorization, or Opportunity to Object is NOT required for Use or Disclosures

The following categories describe different ways that we use and disclosure health information. For each category we will explain what we mean and try to give some examples. These uses and disclosures are allowed without your consent or authorization under the following circumstances:

• As required by law. We will disclose health information about you when required to do so by federal, state or local law.

• Health Oversight Activities. We may disclose health information to a public health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure (e.g., to investigate complaints against providers). These activities are necessary for the government to monitor the health care system, government programs (e.g., to investigate Medicare or Medicaid fraud), and compliance with civil rights laws.

• Public health purposes. We may disclose health information about you for public health and safety purposes. PHI may also be used or disclosed if you have been exposed to a communicable disease or are at risk of spreading a disease or condition.

• Domestic violence or abuse situations. We may disclose PHI when authorized by law to report information about abuse, neglect or domestic violence to public authorities if a reasonable belief exists that you may be a victim of abuse, neglect or domestic violence. In such a case, the Fund will promptly inform you that such a disclosure has been or will be made unless that notice would cause a risk of serious harm.

• Lawsuits and other legal proceedings. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena or discovery request that is accompanied by a court order.

• Law Enforcement. We may release health information if asked to do so by a law enforcement official (for example to report certain types of wounds):

  • In response to a court order, subpoena, warrant, summons or similar process;

  • To identify or locate a suspect, fugitive, material witness, or missing person;

  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement because of emergency circumstances.

•  Coroners, medical examiners and funeral directors. We may release PHI to a coroner or medical examiner when necessary for identifying a deceased person or determining a cause of death. We may also release health information to funeral directors to carry out their duties with respect to the deceased individual.

• Organ and tissue donation. We may also disclose PHI to organizations that handle organ, eye or tissue donation and transplantation.

• Research.  Under certain circumstances, we may use or disclose PHI for research purposes.  

• To prevent a serious threat to health or safety. We may use and disclose health information about you when necessary to prevent or lessen a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to a person reasonably able to help prevent or lessen the threat.

• Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your PHI to the correctional institution or a law enforcement official for the institution to provide health care to you, for your health and safety or the health and safety of others, or the safety and security of the correctional institution.

• Workers’ compensation programs. We may release health information about you for workers' compensation or other similar programs established by law that provide benefits for work-related injuries or illnesses.

Contacting You

The Fund or its health insurance issuers, HMOs, or prescription drug benefit managers, may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

We will use and disclose your health information in a responsible manner for the purposes listed above. We will use or disclose your health information for other purposes only if you have authorized us to do so and subject to your right to revoke the authorization.

Section 3: Your Individual Privacy Rights

Your Right to Inspect and Copy PHI

You have the right to inspect and obtain a copy of your PHI contained in the Fund’s “designated record set”.  This “designated record set” includes your medical records and billing records that are maintained by or for a covered health care provider. Those records include enrollment, payment, billing, claims processing and case management record systems maintained by the Fund or other information used to make decisions about you. Information used for quality control or peer review analyses and not used to make decisions about you is not included. You may inspect and copy the information for as long as the Fund maintains it.

To inspect and copy this medical information, you will be required to complete the Fund’s “Request for Access to PHI” form. You may obtain this form by calling the Fund Office or from the Fund’s website at http://www.oefunds.org. Submit the written request to: Privacy Officer, Operating Engineers Funds, Inc., 100 E. Corson St., Pasadena, CA 91103, (626) 356-1000, privacyofficer@oefi.org.

If you request a copy of the information, we will charge a fee for the costs of copying, mailing or other supplies associated with your request. In lieu of providing a complete copy of all of your records, we will offer to provide you with a written summary of the information, if you agree to the summary and the required fee.

We must send you the requested information within 30 days if the information is maintained at the Fund Office in Pasadena or within 60 days if the information is maintained at another location. A 30-day extension is allowed if we are unable to comply with the deadline.

Note that under federal law, you may not inspect or copy psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and any PHI that is subject to law that prohibits access to PHI.

We may deny your request to inspect and copy in certain limited circumstances. If access is denied, you or your personal representative will be provided with a written denial explaining the basis for the denial, a description of how you may request a review, and a description of how you may complain to the Fund and to the Secretary of the Department of Health and Human Services.

You May Request Restriction on the Use and Disclosure of PHI

You may request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to family members, relatives, friends, or other persons identified by you who are involved in your care. For example, you could ask that we not use or disclose information about a surgery you had.

To request restrictions, you must complete the Fund’s “Request for Restrictions on Use and/or Disclosure of PHI” form and submit the written request to: Privacy Officer, Operating Engineers Funds, Inc., 100 E. Corson St., Pasadena, CA 91103, (626) 356-1000, privacyofficer@oefi.org. You may obtain this form by calling the Fund Office. In your 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.

However, the Fund is not required to agree to any restriction that you request. If, for example, your requested restriction would interfere with our ability to pay your claims, your request would be considered unreasonable and would be denied. If we deny your request, we will notify you in writing with the reason for our denial.

Your Right to Request Confidential Communication

If you believe that a disclosure of all or part of your PHI may endanger you, you have the right to request that we communicate with you about health matters in an alternative way or at an alternative location. For example, you can ask that we only contact you at work or by mail.

To request an alternative method of communication, you must complete a “Request for Confidential Communication” form and submit it to: Privacy Officer, Operating Engineers Funds, Inc., 100 E. Corson St., Pasadena, CA 91103, (626) 356-1000, privacyofficer@oefi.org. You may obtain this form by calling the Fund Office. You must specify on the form how or where you wish to be contacted.

We will accommodate all reasonable requests; however, we may deny a request if it imposes an unreasonable administrative burden on the Fund.

Your Right to Amend Your PHI

If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information for as long as the protected health information is kept by or for the Fund.

To request an amendment, you will be required to complete the Fund’s “Request to Amend PHI” form. You may obtain this form by calling the Fund Office or from the Fund’s website at http://www.oefunds.org. Submit the written request to:  Privacy Officer, Operating Engineers Funds, Inc., 100 E. Corson St., Pasadena, CA 91103, (626) 356-1000, privacyofficer@oefi.org. In addition, you must provide a reason that supports your request.

The Fund has 60 days after receiving your request to act on it. A single 30-day extension is allowed if the Fund is unable to comply with the deadline.

We may deny your request 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:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

• Is not part of the medical information kept by the Fund;

• Is not part of the information which you would be permitted to inspect and copy; or

• Is accurate and complete.

If we deny your request, you or your personal representative may submit a written statement disagreeing with the denial and have that statement included with any future disclosures of that PHI.

Your Right to an Accounting of the Fund’s PHI Disclosures 

You have the right to request an “accounting of disclosures” by the Fund of your health information during the six years preceding your request. However, we do not have to provide you with an accounting of disclosures related to treatment, payment or health care operations, or disclosures made to you about your own health information or authorized by you in writing, or any disclosures we may have made prior to April 14, 2003.

To request this list or accounting of disclosures, you must submit your request in writing to: Privacy Officer, Operating Engineers Funds, Inc., 100 E. Corson St., Pasadena, CA 91103, (626) 356-1000, privacyofficer@oefi.org. You may obtain a “Request for Accounting of PHI Disclosures” form by calling the Fund Office. Your request must indicate a time period which may not be longer than six years or include any dates before April 14, 2003.

If you request more than one accounting within a 12-month period, we may charge you a reasonable fee for each subsequent accounting.

If the accounting cannot be provided within 60 days, an additional 30 days is allowed if we provide you with a written statement of the reasons for the delay and a date by which we will provide the accounting.

Your Right to Receive a Paper Copy of This Notice on Request

You may ask us to give you a copy of this notice at any time. You may obtain a copy of this notice at our website, http://www.oefunds.org. To obtain a paper copy of this Notice contact: Privacy Officer, Operating Engineers Funds, Inc., 100 E. Corson St., Pasadena, CA 91103, (626) 356-1000, privacyofficer@oefi.org.

Your Personal Representative

You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of his /her authority to act on your behalf before that person will be given access to your health information or allowed to take any action for you. Proof of such authorization will be a signed and approved “Appointment of Personal Representative” form. You may obtain this form by calling the Fund Office.

The Fund retains the right to deny access to your health information to a personal representative to protect vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect. This also applies to personal representatives of minor children.

The Fund will recognize certain people as your personal representatives without your having to complete an “Appointment of Personal Representative” form. For example, the Fund will automatically consider your spouse to be your personal representative as long as we can verify his/her identity by asking for certain facts or information in your spouse’s file and, if in person, by requiring photo identification. In addition, the Fund will consider a parent or guardian as the personal representative of an unemancipated minor, unless the law requires otherwise, as long as we can verify the individual’s identity and authority by asking for certain facts of information in the child’s file. A spouse or a parent may act on an individual’s behalf, including requesting access to their PHI. Spouses and unemancipated minors may, however, request that the Fund restrict information that goes to family members as described above in the section entitled “You May Request Restriction on the Use and Disclosure of PHI”.

You may also review the Fund’s Policy and Procedure for the Recognition of Personal Representative for a more complete description of the circumstances where the Fund will automatically consider an individual to be a personal representative.

Section 4: The Fund’s Duties

Maintaining Your Privacy

The Fund is required by law to maintain the privacy of your PHI and to provide you and your eligible dependents with notice of its legal duties and privacy practices.

This notice is effective beginning on April 14, 2003 and the Fund is required to comply with the terms of this Notice. However, the Fund reserves the right to change its privacy practices and to apply the changes to any PHI received or maintained by the Fund prior to that date. If a privacy practice is changed, a revised version of this Notice will be provided to you and to participants and beneficiaries then covered by the Plan.

Any such revised Notice will be mailed to you. It will be distributed within 60 days of the effective date of any material change to the uses and disclosures of PHI, your individual rights, the duties of the Fund, or other privacy practices stated in this Notice.

Disclosing Only the Minimum Necessary PHI

When using or disclosing PHI or when requesting PHI from another covered entity, the Fund will make reasonable efforts not to use, disclose or request more than the minimum amount of PHI necessary to accomplish the intended purpose of the use, disclosure or request, taking into consideration practical and technological limitations.

However, the minimum necessary standard will NOT apply in the following situations:

• Disclosures to or requests by a health care provider for treatment,

• Uses or disclosures made to you,

• Disclosures made to the Secretary of the U.S. Department of Health and Human Services pursuant to its enforcement activities under the Health Insurance Portability and Accountability Act of 1996, known as HIPAA,

• Uses or disclosures required by law, and

• Uses or disclosures required for the Fund’s compliance with the HIPAA privacy regulations.

This notice does not apply to information that has been de-identified. De-identified information is information that does not identify you and with respect to which there is no reasonable basis to believe that the information can be used to identify you.

In addition, the Fund may use or disclose “summary health information” to the Board of Trustees for obtaining premium bids or modifying, amending or terminating the group health Plan. Summary information summarizes the claims history, claims expenses or type of claims experienced by individuals covered by the Plan. Identifying information will be deleted from summary health information, in accordance with HIPAA.

Section 5: Your Right to File a Complaint with the Fund or the Secretary of HHS

If you believe that your privacy rights have been violated, you may file a complaint with the Fund in care of: Privacy Officer, Operating Engineers Funds, Inc., 100 E. Corson St., Pasadena, CA 91103, (626) 356-1000, privacyofficer@oefi.org.

Or you may file a complaint with the Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201.

The Fund will not retaliate against you and there is no penalty for filing a complaint.

Section 6:  If You Need More Information

If you have any questions regarding this notice or the subjects addressed in it, you may contact the following office: Privacy Officer, Operating Engineers Funds, Inc., 100 E. Corson St., Pasadena, CA 91103, (626) 356-1000, privacyofficer@oefi.org.

Section 7: Conclusion

The use and disclosure of PHI by the Fund is regulated by the federal government under the Health Insurance Portability and Accountability Act, known as HIPAA. You may find these rules at 45 Code of Federal Regulations Parts 160 and 164. This notice is a summary of the regulations. The regulations will supersede any discrepancy between the information contained in this notice and the regulations.