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Notice of Privacy Practices Effective April 14, 2003 |
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| Overview | 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. |
| Purpose | The purpose of this notice is to:
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| VSP’s Responsibilities | VSP is required to abide by the terms of this notice currently in effect by:
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| Notice Revisions | VSP reserves the right to revise the terms of this notice, and to make the revised terms effective for all Protected Health Information that it maintains. If VSP revises this notice, we will make the revised notice available within sixty (60) days. |
DEFINITIONS |
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| Business Associate | A person or entity that uses Protected Health Information to perform a service for VSP. These services
include, but are not limited to:
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| Health Care Operations |
Activities related to VSP’s operations, including but not limited to:
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| Payment | VSP’s collection of insurance premiums or its determination and payment of claims. |
| Protected Health Information |
Information relating to a VSP patient’s past, present or future health or condition,
the provision of health care to a VSP patient, or payment for the provision of health
care to a VSP patient. Protected Health Information includes, but is not limited to:
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| Treatment | The provision, coordination or management of vision care and related services by one or more vision care providers. |
PRIVACY PRACTICES |
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| How VSP Uses and Discloses Information About You |
VSP will only use and disclose your Protected Health Information without your
authorization when
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| Disclosure to VSP’s Business Associates |
VSP will only disclose your Protected Health Information to Business Associates who have agreed in writing to maintain the privacy of Protected Health Information as required by law. |
| Use or Disclosure Requiring Authorization |
VSP will not use or disclose your Protected Health Information for purposes other than those described in this notice. If it becomes necessary to disclose any of your Protected Health Information for other reasons, VSP will request your written authorization. Revoking Authorization: If you provide written authorization, you may revoke it at any time in writing, except to the extent that VSP has relied upon the authorization prior to its being revoked. |
| Use or Disclosure Required or Permitted by Law |
VSP may use or disclose your Protected Health Information to the extent that the
law requires the use or disclosure:
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| Use and Disclosure Examples |
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KNOW YOUR RIGHTS |
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| Review Your Protected Health Information |
You have a right to inspect and obtain a copy of your Protected Health Information. Important: If you feel your Protected Health Information is incorrect, you have the right to request that it be amended. |
| Request to Restrict Your Protected Health Information |
You can request restrictions on the use and disclosure of your Protected Health Information. VSP is not
required to agree to a requested restriction. Example: If a restriction request prevents us from providing service to you or from performing payment related functions, we will not be able to agree to the request. |
| Confidential Communication |
When necessary, VSP mails your Protected Health Information to your home. If you feel receiving a copy
of your Protected Health Information at your home could compromise your safety, you may request in
writing, an alternate communication method and/or location. Important: VSP will not ask for an explanation for such requests, but may request payment for this service. Examples: The patient may decide, for his or her safety, to have correspondence containing his or her Protected Health Information sent somewhere other than to his or her home, or to have the information sent via fax rather than mailed. |
| Accounting of Disclosures |
If a disclosure of your Protected Health Information was made for a reason other than treatment,
payment or health care operations, you have a right to receive an accounting of the disclosure. Important: If the disclosure was made to you, VSP will not provide an accounting. |
| Receive a Copy | You can view and print a copy of this Notice of Privacy Practices through vsp.com. You may also request a copy from your Benefit Administrator, or you may request a paper copy from VSP. |
| Complaints | If you believe that your privacy rights have been violated, you may submit a complaint to VSP or to the
U.S. Secretary of Health and Human Services at any time. VSP will not retaliate against you for filing a
complaint. File complaints with VSP at vsp.com, or by calling our Member Services Department at 800-877-7195, for complaints regarding:
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CONTACT INFORMATION |
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| Contact VSP | Contact VSP Contact us through vsp.com, or call our Member Services Department at 800-877-7195 to request:
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