Member Service Center
Privacy Practice 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 effective December 2012, to view PDF please click here.
WHO WE ARE
This Notice describes the health information privacy practices of Security
Health Plan of Wisconsin, Inc. ("we" or "us"). We provide health benefits to you under the
terms of a health insurance policy or under other health benefit programs such as
BadgerCare/Medicaid or a Medicare+Choice plan. Federal Law requires us to provide this
Notice to you.
OUR PRIVACY OBLIGATIONS
Your privacy is important to us and we are concerned about the confidentiality
of medical records and other personal information. In addition, we are required by federal
and state law to protect the privacy of health information and to provide you with this Notice
of our legal duties and privacy practices. When we use or disclose your health information,
we are required to follow the practices described in this Notice (or other notice in effect at
the time of the use or disclosure).
We must follow either federal or state law, whichever is more protective of
your privacy rights. For example, if federal law allows certain disclosures of your health
information without your written authorization but state law requires your written
authorization, we must follow State law.
We may change the privacy practices described in this Notice at any time.
Changes would apply to all health information we maintain at the time of the change. If
we change our practices, we will send the new notice to you if you are then covered by
us. In addition, we will post any new notice on our Internet site at
also may obtain any new notice by contacting us as described at the end of this
HOW WE MAY USE AND DISCLOSE YOUR INFORMATION
In certain situations described in the section below entitled Limits On Our Use
or Disclosure of Your Information, we must obtain your written authorization to use and/or
disclose your health information. However we do not need such authorization to use and
disclose your health information for the following purposes:
Treatment. We may disclose your health information to your health care
provider for the provider’s treatment of you. Treatment is the provision, coordination, or
management of your health care and related services – for example, evaluating treatment
Payment. We may use and disclose your health information to obtain payment
of premiums for your coverage and to determine and fulfill our responsibility to provide your
health plan benefits – for example, to make coverage determinations such as whether a
service is experimental, to administer claims, and to coordinate benefits with other coverage
you may have. We may also disclose your health information to another health plan or a
health care provider for its payment activities - for example, for the other health plan to
determine your eligibility.
Health Care Operations. We may use and disclose your health information for
our health care operations - for example, to provide customer service, to conduct quality
assessment and improvement activities, or credentialing activities. We also may disclose
your health information to another health plan or a health care provider that has or had a
relationship with you so that it can conduct certain of these activities - for example, for the
other health plan to perform case management.
Plan Sponsors. We may disclose to group health plan sponsors certain health
information to the extent reasonably necessary for specific plan administration
Marketing Communications. We may provide you with marketing materials in a
face-to-face encounter or provide a promotional gift of nominal value. We may also contact
you to give you information about certain health related benefits and services that may be
of interest to you.
Public Health Activities. If required or allowed by law, we may disclose your
health information to public health authorities to: (1) prevent or control disease, injury, or
disability; (2) report child abuse or neglect; (3) report domestic violence; (4) report to the
U.S. Food and Drug Administration problems with products and reactions to medications;
and (5) report disease or infection exposure.
Health Oversight Activities. We may disclose your health information to an
insurance regulatory authority and other government agencies legally responsible for
oversight of the health care system or ensuring compliance with the rules of government
benefit programs. This disclosure may include health information related to beneficiary
eligibility or other regulatory programs, such as civil right laws.
Judicial and Administrative Proceedings. We may disclose your health
information in a judicial or administrative proceeding in response to a legal order or other
Law Enforcement Officials. We may disclose your health information to the
police or other law enforcement officials as required or allowed by law or to comply with
an administrative or court order, such as a subpoena, or to protect us against fraud or
other illegal activity.
Health or Safety. We may disclose your health information to prevent or
lessen a serious and imminent threat to the health or safety of an individual or the general
Specialized Government Functions. We may disclose your health information
to units of the government with special functions, such as the U.S. military or the U.S.
Department of State.
Workers’ Compensation. We may disclose your health information as
necessary to comply with Workers’ Compensation or similar laws.
Coroners, Medical Examiners and Funeral Directors. We may release health
information to a coroner, medical examiner, or funeral director as permitted by law to carry
out their duties.
Inmates. If you are an inmate of a correctional institution or under the custody
of law enforcement, we may disclose information for certain purposes. For example, we
may disclose information necessary to provide you with health care.
Research. There are situations when researchers and research staff may
use or disclose your health information for research purposes without your authorization.
Researchers may conduct research that simply involves reviewing your health information
and that of others with similar conditions or diseases. In such situations, researchers will
not contact you for your authorization, but must obtain permission from the Institutional
Review Board that is set up to protect the welfare and privacy of research participants as
required by law. Researchers may also review your health information to see if there are
enough persons with a specific disease or condition to conduct a study or to see if you
would be a good candidate for a study.
Business Associates. We may disclose your health information to persons or
organizations that perform a service for or on our behalf that requires the use or disclosure
of health information. Such persons or organizations are our business associates. For
example, we may disclose your health information to the pharmacy benefits management
company that processes our prescription drug claims.
To Comply With the Law. We may disclose your health information when
required by any other law not already referred to in this Notice.
Relatives and Other Caregivers. We may disclose your health information when required by any other law not already referred to in this Notice. Limited health information may also be disclosed to organizations involved in disaster relief efforts.
To Comply With the Law. In certain limited situations, we may disclose
health information to people, such as family members, who are involved in your care or
payment for your care. The information disclosed would be limited to information we believe
is directly relevant to their involvement and only to the extent we determine it would be in
your best interest. Limited health information may also be disclosed to organizations involved
in disaster relief efforts.
LIMITS ON OUR USE OR DISCLOSURE OF YOUR INFORMATION
Disclosures with an Authorization. We may only use or disclose your health
information for purposes other than those described above when you give us your
permission on the Security Health Plan authorization form. This means we may not be able to share certain
information with your spouse, parent, or child without an authorization signed by you. You
may revoke an authorization unless we have relied on it or the state law gives us the right
to contest a claim or the policy itself and the authorization was obtained as a condition of
obtaining insurance coverage. The revocation must be in writing and sent to us.
Uses and Disclosures of Your Highly Confidential Information. Federal and/or
state law require special privacy protections for certain highly confidential information about
you. This includes information about mental health and developmental disabilities services;
alcohol and drug abuse prevention, treatment and referral; and HIV/AIDS testing. These laws
may restrict our uses and disclosures beyond the general limitations described in this
YOUR INDIVIDUAL RIGHTS
Right to Request Additional Restrictions. You may ask for restrictions on uses
and disclosures of your health information: (1) for treatment, payment and health care
operations; (2) to family or friends involved in your care or payment for care or ; (3) for
disaster relief efforts. While we will consider all requests for additional restrictions, we are
not required to agree to your request. To ask for a restriction, you must obtain an Authorization to Use and Disclose Personal Health Information (Family and/or Friend) form from Security Health Plan Customer Service and submit the completed form to our Privacy Office. We will send you a written response.
Right to Request Confidential Communications. We will accommodate a
reasonable request to receive communications of your health information from us by alternative
means of communication or at alternative locations if the request clearly states that disclosure
of that information could endanger you. For example, you may request that we send materials
to a P.O. Box instead of a street address. To make a request, you must obtain a Request for Confidential Communications form from Security Health Plan Customer Service and submit the completed form to us.
Right to Inspect and Copy Your Health Information. You may have access to our
records that contain your health information and are used to make decisions about your benefits.
Under limited circumstances, we may deny you access to a portion of your records, such as
mental health records or information gathered for a judicial proceeding. To request access, you
must obtain an Access Request for Protected Health Information form from Security Health Plan Customer Service and submit the completed form to our Privacy Office.
There may be charges, such as copying and mailing costs, and costs of preparing an explanation
or summary, if applicable. You should note that, if you are a parent or legal guardian of a minor
(child under age 18), certain portions of the minor’s health information may not be accessible to
you (for example, records related to alcohol or other drug abuse).
Right to Request Amendment of Your Records. You have the right to request that
we amend your health information maintained in our records. To request amendment, you must
obtain a Request for Amendment of Health Information form from Security Health Plan Customer Service and submit the completed form to our Privacy Office. All
requests for amendment must be in writing. We may deny your request if certain circumstances
apply. If your physician or other health care provider created the information that you desire to
amend, you should contact the provider to amend the information.
Right to Accounting of Disclosures. You may ask for a list of certain disclosures of
your health information made by us, if any, on or after April 14, 2003. (In certain circumstances,
Wisconsin law allows you to receive information about disclosures made prior to April 14, 2003.)
This list will not include disclosures made to you, for treatment, payment, and health care
operations, or for certain other purposes. To request such a list, you must obtain an Accounting Request for Disclosures of Individually Identifiable Health Information form from
Security Health Plan Customer Service and submit the completed form to our Privacy Office. If you request a list more
than once during any 12 month period, we will charge you a reasonable fee for the additional
Right to a Paper Copy of This Notice. You may ask for a paper copy of this Notice,
even if you previously agreed to receive it electronically. You may also access this Notice on
our Internet site at
Complaints. If you are concerned that we have violated your privacy rights, you
may contact our Privacy Hotline by calling our 800 number shown below. You may also file written complaints
with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate
against you if you file a complaint.
Further Information. If you have any questions or would like additional information
about your rights or the information in this Notice, you may contact Customer Service as shown
Security Health Plan
1515 Saint Joseph Avenue
P.O. Box 8000
Marshfield, WI 54449-8000
866-339-0289 Privacy Hotline
715-221-9555 - Customer Service Center
Regional Office - Wausau
One Corporate Drive
Wausau, WI 54401
866-339-0289 Privacy Hotline
715-221-9555 - Customer Service Center