FB Healthcare - HSA Plans

Group Health Plan Privacy Notice

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.

This notice is not part of your Plan Documents. It is provided for informational purposes only.

This notice provides information to individuals who may receive group health benefits such as a medical, dental, prescription drug or other health care benefits through the Washington Farm Bureau (the "Plan") which are offered by an employer (the "Plan Sponsor"). Whenever the words "we," "us," or "our" appear in this notice, the words refer to any Washington Farm Bureau group health plan sponsored by the employer. "You" and "your" refer to individuals who are covered by the Plan.

The Plan is required by law to protect the privacy of your medical information and to give you this notice. It explains how we use and disclose medical information, describes your privacy rights and provides a contact for additional information or complaints. The Plan will use and disclose your medical information as described in this notice and is obligated to comply with the terms of this notice.

You should know that our privacy practices may not be the same as those used by your doctor or other organizations. Please check with them if you would like to understand their privacy practices. You may also receive separate privacy notices from the insurance companies that insure any of your group health benefits.

This Notice does not apply to medical information relating to employment, disability, workers' compensation, life insurance benefits or any other health information not created or received by the Plan. For example, this notice does not apply to employment records such as pre-employment screenings or to requests for medical leave.

The Plan reserves the right to change this notice at any time and to make the changes apply to all medical information about you maintained by the Plan before and after the effective date of the new notices. If we make a change, a new notice will be sent to all participants covered by the Plan at that time.

What is Protected Health Information?

The Plan provides benefits to you as described in the Summary Plan Descriptions you receive. The Plan receives and maintains health information about you in the course of providing these benefits to you and in the course of administering the Plan. The term "Protected Health Information" (PHI) is a term used under federal law protecting the privacy of your medical records and it includes all "Individually Identifiable Health Information" transmitted or maintained by the Plan, regardless of form (oral, written or electronic). The term "Individually Identifiable Health Information" means information that:

* Is created or received by a health care provider, health plan or health care clearinghouse;
* Relates to the past, present or future physical or mental health or condition of an individual;
* Relates to the provision of health care to an individual;
* Relates to the past, present or future payment for the provision of health care to an individual; and
* Identifies the individual, or the information can be used to determine the identity of the individual.

Understanding what PHI is and how it is used will help you make more informed decisions if you are asked to sign an authorization to disclose your PHI to others, as may be required by the federal regulations. Whenever you see the abbreviation PHI in this notice, we mean the health information described above.

What are Your Rights?

You have legal rights regarding your PHI in the records we create and maintain. These rights are described below. In most cases, your PHI is created or maintained by third parties, such as doctors and insurers and companies who work for us also known as the Plan's Business Associates, and you may be asked to contact them directly regarding the exercise of your rights. To exercise any of these rights, a written request must be submitted to:
Privacy Officer
Washington Farm Bureau Service Company
8767 - 148th Ave. NE
Redmond, Washington 98052

Right to Inspect and Copy Records - With some exceptions, you have the right to review and copy your health information. We may charge a fee for the cost of copying, mailing, or other supplies associated with your request
Right to Correct Inaccurate Records - You have the right to request an amendment of your health information when it is incorrect or incomplete. This right exists as long as we keep this information.
Right to an Accounting of Disclosures - You have the right to obtain a listing of those to whom we have disclosed your health information. This right applies to disclosures other than those made for treatment, payment, health care operations and those you specifically authorized. You can request an accounting for up to 6 years prior to the date of the request but not prior to April 14, 2003. The first request in a 12-month period is provided at no cost to you. There may be a charge for subsequent requests within the same 12-month period.
Right to Request Restrictions - You have the right to request restrictions on the use or disclosure of your health information. We will use our best efforts to comply with all approved requests. We will provide you with a written explanation for denied requests or when we revoke a previously agreed to restriction.
Right to Confidential Communications - You have the right to ask that communication with you be made in a particular way or be sent to a certain location to protect your privacy. We will attempt to meet all reasonable requests.
Right to a Paper Copy of this Notice - Even though we post a copy of this notice on our web site www.fbbenefits.com, you may request a paper copy of this Notice at any time.
Right to Require Written Authorization - Any uses or disclosures of your health information, other than those described below, will be made only with your advance written authorization, which you may give or take away at any time.

How do We use and disclose Your Health Information?

The following are the different ways the Plan may use and disclose your protected health information without your authorization or consent:

To Administer the Plan - We use your information for treatment, payment and health care operations by the Plan, its Business Associates, and their agents/subcontractors.
Treatment is the provision, coordination or management of health care and related services by one or more health care providers. It also includes, but is not limited to, consultations and referrals between health care providers. For example, the Plan may disclose to a primary care physician the name of a treating specialist.
Payment means activities such as billing, claims management, coordination of benefits, medical necessity review, subrogation, utilization review, and so on. For example, we may tell a provider whether you are eligible for coverage or what percentage of the bill will be paid by the Plan. The Plan may also disclose PHI to a close friend or family member involved in or who helps pay for your health care.
Health care operations means activities to carry out Plan operations, such as underwriting, premium rating and other insurance activities, disease management, medical review, legal services and auditing, and general administrative activities. For example, we may review the competence or qualifications of health care professionals and conduct quality assessment activities. We may also buy insurance for the Plan or contract for claims and plan administration or other services.
Communication with You - The Plan may contact you to give you information about treatment alternatives or other health-related benefits and services that may be of interest to you.
As Required By Law - The Plan must allow the U.S. Department of Health and Human Services to audit Plan records. The Plan may also disclose medical information about you as authorized and to the extent necessary to comply with workers' compensation or other similar laws.
To Business Associates - The Plan may disclose PHI about you to the Plan's business associates. Each business associate of the Plan must agree in writing to protect your confidentiality and the security of PHI. An example of one of our business associates is the third party administrator that assists the Plan in plan administration activities.
To a Plan Sponsor - The Plan may disclose PHI to the Plan Sponsor, in summary form, the group's claims history and other similar information without specific information about you. The Plan may also disclose specific medical information about you to the Plan Sponsor for Plan administration functions. However, we will only provide this information about you to the Plan Sponsor when the Plan Sponsor has agreed to comply with privacy law restrictions on use of this information. Unless authorized by you in writing, your health information cannot be used by your employer for any employment-related actions and decisions.
Your PHI may also be used and disclosed as follows:

* To comply with legal proceedings, such as a court or administrative order or subpoena;
* To law enforcement officials as required for limited law enforcement purposes;
* To your personal representatives appointed by you or designated by applicable law;
* To a coroner, medical examiner, or funeral director about a deceased person;
* To an organ procurement organization in limited circumstances;
* To avert a serious threat to your health or safety or the health or safety of others;
* To a governmental agency authorized to oversee the health care system or government programs.
* For specialized government functions (e.g., military and veterans activities, national security and intelligence, federal protective services, medical suitability determinations, correctional institutions and other law enforcement custodial situations);
* To public health authorities for public health purposes;
* We may disclose to one of your family members, to a relative, to a close personal friend, or to any other person identified by you, Protected Health Information that is directly relevant to the person's involvement with your care or payment related to your care; and
* If you authorize the use or disclosure in writing.

Filing a Complaint

If you believe that your privacy rights have been violated, you have the right to complain to the Plan. Any complaint must be in writing and mailed to the person identified below under "Contact Information." Your complaint must be submitted within 180 days of when you believe the violation occurred. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services. If you do complain, we will not take any action against you or otherwise retaliate because you complained.

Contact Information
If you have questions regarding this notice or the subjects addressed in it, you may contact:
FB Healtcare
1.800.681.7177

Copyright © 2006 - All Rights Reserved Washington Farm Bureau Service Company Inc. Trademark and Copyright Notices

To find out more please call: 1-800-681-7177


Regence Asuris Plan Comparisons Coverage Area Forms Individual Plans Medicare Plans Vision Plans Dental Plans Contact us Become a Farm Bureau Member	Group Health Plan Privacy Notice 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. This notice is not part of your Plan Documents. It is provided for informational purposes only. This notice provides information to individuals who may receive group health benefits such as a medical, dental, prescription drug or other health care benefits through the Washington Farm Bureau (the "Plan") which are offered by an employer (the "Plan Sponsor"). Whenever the words "we," "us," or "our" appear in this notice, the words refer to any Washington Farm Bureau group health plan sponsored by the employer. "You" and "your" refer to individuals who are covered by the Plan. The Plan is required by law to protect the privacy of your medical information and to give you this notice. It explains how we use and disclose medical information, describes your privacy rights and provides a contact for additional information or complaints. The Plan will use and disclose your medical information as described in this notice and is obligated to comply with the terms of this notice. You should know that our privacy practices may not be the same as those used by your doctor or other organizations. Please check with them if you would like to understand their privacy practices. You may also receive separate privacy notices from the insurance companies that insure any of your group health benefits. This Notice does not apply to medical information relating to employment, disability, workers' compensation, life insurance benefits or any other health information not created or received by the Plan. For example, this notice does not apply to employment records such as pre-employment screenings or to requests for medical leave. The Plan reserves the right to change this notice at any time and to make the changes apply to all medical information about you maintained by the Plan before and after the effective date of the new notices. If we make a change, a new notice will be sent to all participants covered by the Plan at that time. What is Protected Health Information? The Plan provides benefits to you as described in the Summary Plan Descriptions you receive. The Plan receives and maintains health information about you in the course of providing these benefits to you and in the course of administering the Plan. The term "Protected Health Information" (PHI) is a term used under federal law protecting the privacy of your medical records and it includes all "Individually Identifiable Health Information" transmitted or maintained by the Plan, regardless of form (oral, written or electronic). The term "Individually Identifiable Health Information" means information that: * Is created or received by a health care provider, health plan or health care clearinghouse; * Relates to the past, present or future physical or mental health or condition of an individual; * Relates to the provision of health care to an individual; * Relates to the past, present or future payment for the provision of health care to an individual; and * Identifies the individual, or the information can be used to determine the identity of the individual. Understanding what PHI is and how it is used will help you make more informed decisions if you are asked to sign an authorization to disclose your PHI to others, as may be required by the federal regulations. Whenever you see the abbreviation PHI in this notice, we mean the health information described above. What are Your Rights? You have legal rights regarding your PHI in the records we create and maintain. These rights are described below. In most cases, your PHI is created or maintained by third parties, such as doctors and insurers and companies who work for us also known as the Plan's Business Associates, and you may be asked to contact them directly regarding the exercise of your rights. To exercise any of these rights, a written request must be submitted to: Privacy Officer Washington Farm Bureau Service Company 8767 - 148th Ave. NE Redmond, Washington 98052 Right to Inspect and Copy Records - With some exceptions, you have the right to review and copy your health information. We may charge a fee for the cost of copying, mailing, or other supplies associated with your request Right to Correct Inaccurate Records - You have the right to request an amendment of your health information when it is incorrect or incomplete. This right exists as long as we keep this information. Right to an Accounting of Disclosures - You have the right to obtain a listing of those to whom we have disclosed your health information. This right applies to disclosures other than those made for treatment, payment, health care operations and those you specifically authorized. You can request an accounting for up to 6 years prior to the date of the request but not prior to April 14, 2003. The first request in a 12-month period is provided at no cost to you. There may be a charge for subsequent requests within the same 12-month period. Right to Request Restrictions - You have the right to request restrictions on the use or disclosure of your health information. We will use our best efforts to comply with all approved requests. We will provide you with a written explanation for denied requests or when we revoke a previously agreed to restriction. Right to Confidential Communications - You have the right to ask that communication with you be made in a particular way or be sent to a certain location to protect your privacy. We will attempt to meet all reasonable requests. Right to a Paper Copy of this Notice - Even though we post a copy of this notice on our web site www.fbbenefits.com, you may request a paper copy of this Notice at any time. Right to Require Written Authorization - Any uses or disclosures of your health information, other than those described below, will be made only with your advance written authorization, which you may give or take away at any time. How do We use and disclose Your Health Information? The following are the different ways the Plan may use and disclose your protected health information without your authorization or consent: To Administer the Plan - We use your information for treatment, payment and health care operations by the Plan, its Business Associates, and their agents/subcontractors. Treatment is the provision, coordination or management of health care and related services by one or more health care providers. It also includes, but is not limited to, consultations and referrals between health care providers. For example, the Plan may disclose to a primary care physician the name of a treating specialist. Payment means activities such as billing, claims management, coordination of benefits, medical necessity review, subrogation, utilization review, and so on. For example, we may tell a provider whether you are eligible for coverage or what percentage of the bill will be paid by the Plan. The Plan may also disclose PHI to a close friend or family member involved in or who helps pay for your health care. Health care operations means activities to carry out Plan operations, such as underwriting, premium rating and other insurance activities, disease management, medical review, legal services and auditing, and general administrative activities. For example, we may review the competence or qualifications of health care professionals and conduct quality assessment activities. We may also buy insurance for the Plan or contract for claims and plan administration or other services. Communication with You - The Plan may contact you to give you information about treatment alternatives or other health-related benefits and services that may be of interest to you. As Required By Law - The Plan must allow the U.S. Department of Health and Human Services to audit Plan records. The Plan may also disclose medical information about you as authorized and to the extent necessary to comply with workers' compensation or other similar laws. To Business Associates - The Plan may disclose PHI about you to the Plan's business associates. Each business associate of the Plan must agree in writing to protect your confidentiality and the security of PHI. An example of one of our business associates is the third party administrator that assists the Plan in plan administration activities. To a Plan Sponsor - The Plan may disclose PHI to the Plan Sponsor, in summary form, the group's claims history and other similar information without specific information about you. The Plan may also disclose specific medical information about you to the Plan Sponsor for Plan administration functions. However, we will only provide this information about you to the Plan Sponsor when the Plan Sponsor has agreed to comply with privacy law restrictions on use of this information. Unless authorized by you in writing, your health information cannot be used by your employer for any employment-related actions and decisions. Your PHI may also be used and disclosed as follows: * To comply with legal proceedings, such as a court or administrative order or subpoena; * To law enforcement officials as required for limited law enforcement purposes; * To your personal representatives appointed by you or designated by applicable law; * To a coroner, medical examiner, or funeral director about a deceased person; * To an organ procurement organization in limited circumstances; * To avert a serious threat to your health or safety or the health or safety of others; * To a governmental agency authorized to oversee the health care system or government programs. * For specialized government functions (e.g., military and veterans activities, national security and intelligence, federal protective services, medical suitability determinations, correctional institutions and other law enforcement custodial situations); * To public health authorities for public health purposes; * We may disclose to one of your family members, to a relative, to a close personal friend, or to any other person identified by you, Protected Health Information that is directly relevant to the person's involvement with your care or payment related to your care; and * If you authorize the use or disclosure in writing. Filing a Complaint If you believe that your privacy rights have been violated, you have the right to complain to the Plan. Any complaint must be in writing and mailed to the person identified below under "Contact Information." Your complaint must be submitted within 180 days of when you believe the violation occurred. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services. If you do complain, we will not take any action against you or otherwise retaliate because you complained. Contact Information If you have questions regarding this notice or the subjects addressed in it, you may contact: FB Healtcare 1.800.681.7177 Copyright © 2006 - All Rights Reserved Washington Farm Bureau Service Company Inc. Trademark and Copyright Notices To find out more please call: 1-800-681-7177	Have a benefit question? Please call 1.800.681.7177 Monday thru Friday 9:00 a.m. to 5:00 p.m. Medical: Employees with Regence plans go to: myregence.com. Asuris plans go to myasuris.com. Employers with Regence plans go to: wa.regence.com or regencerx.com Request a quote: You must have 2 or more employees working in the business to qualify. To get your estimate started please click here... Request more information: For additional plan information by mail please click here... Find an agent: To find a qualified agent in your area please click here... Find a provider: Find a Doctor in your area.
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