AgdaPkt 2005-06-27 - Laserfiche WebLink

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~/¿1.ð/ . disclosures, such as for national security purposes. Your request for an accounting of disclosures must be made in writing and must state a time period for which you want an accounting. This time period may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what fonn you. want the list (for example, on paper or electronically). The first accounting that you request within a 12-month period will be free. For additional lists within the same time period, we may charge for providing the accounting, but we will tell you the cost in advance. Right To Request Restrictions on the Use and Disclosure of Your Protected Health Information. You have the right to request that we restrict or limit how we use or dis<?lose your protected health infonnation for treatment, payment or health care operations. We may not agree to your request. If we do agree, we will comply with your request unless the infonnation is needed for an emergency. Your request for a restriction must be made in writing. In your request, you must tell us (1) what infonnation you want to limit; (2) whether you want to limit how we use or disclose your infonnation, or both; and (3) to whom you want the restrictions to apply. .. Right To Receive Confidential Communications. You have the right to request that we use a certain method to communicate with you about the Plan or that we send Plan infonnation to a certain location if the communication could endanger you. Your request to receive confidential communications must be made in writing. Your request must clearly state that all or part of the communication from us could endanger you. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. Right to a Paper Copy of This Notice. You have a right at any time to request a paper copy of this Notice, even-if you had previously agreed to receive an electronic copy. Contact Information for Exercising Your Rights. You may exercise any of the rights described above by contacting our privacy office. See the end of this Notice for the contact infonnaiiol1¡ . . . . HEAL TH INFORMA nON SECURITY MHN requires its employees to follow the MHN security policies and procedures that limit access to health infonnation about members to those employees who need it to perfonn their job responsibilities, In addition, MHN maintains physical, administrative and technical security measures to safeguard your protected health infonnation. CHANGES TO THIS NOTICE We reserve the right to change the tenns of this Notice at any time, effective for protected health infonnation that we already have about you as well as any infonnation that we receive in the future. We will provide you with a copy of the new Notice whenever we make a material change to the privacy practices described in this Notice. We also post a copy of our CUITent Notice on our web site at »'ww,MHNcom. Any time we make a material change to this Notice, we will promptly revise and post the new Notice with the new effective date. GRIEVANCES If you believe that your privacy rights have been violated, you may file a grievance with us and/or with the Secretary of the Department of Health and Human Services. All grievances to the Plan must be made in writing and sent to the privacy office listed at the end of this Notice. We support your right to protect the privacy of your protected health infonnation. We will not retaliate against you or penalize you for filing a grievance. 15