SEIU 775 Benefits Group Notice of Privacy Practices
Effective Date: January 2025
This notice describes how your protected health information (PHI) may be used and disclosed by SEIU Healthcare NW Health Benefits Trust (“the Trust”) and how you can get access to this information. Please review this notice carefully. This notice details:
- The Trust’s uses and disclosures of PHI.
- Your rights to privacy with respect to your PHI.
- The Trust’s duties with respect to your PHI.
- Your right to file a complaint with the Trust and with the Secretary of the United States Department of Health and Human Services (HHS).
- The person or office you should contact for further information about the Trust’s privacy practices.
- Any breach of your PHI.
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.
Translation
The HIPAA Privacy Notice is only available on our website in English. If you require a translated version of the HIPAA Privacy Notice, please contact us at mrc@myseiubenefits.org and we will make reasonable efforts to provide you with the necessary information.
What is Protected Health Information (PHI)?
The term “Protected Health Information” includes all individually identifiable health information related to your past, present or future physical or mental health condition or to payment for health care. PHI includes information maintained by the Trust in oral, written or electronic form.
When Can the Trust Disclose Your PHI Without Your Authorization?
We may disclose your PHI in the following cases:
- At your request. If you request it, the Trust is required to give you access to certain PHI in order to allow you to inspect and/or copy it.
- As required by HHS. The Secretary of the United States Department of Health and Human Services may require the disclosure of your PHI to investigate or determine the Trust’s compliance with the privacy regulations.
- The Trust and its business associates will use PHI for treatment, payment or health care operations.
- Payment includes but is not limited to actions to make coverage determinations and payment (including billing, claims management, subrogation, plan reimbursement, reviews for medical necessity and appropriateness of care, and utilization review and preauthorizations).
- Treatment is the provision, coordination or management of health care and related services. It also includes but is not limited to consultations and referrals between one or more of your providers.
- Health care operations include but are not limited to quality assessment and improvement, reviewing competence or qualifications of health care professionals, underwriting, premium rating and other insurance activities relating to creating or renewing insurance contracts. It also includes disease management, case management, conducting or arranging for medical review, legal services, auditing functions including fraud and abuse compliance programs, business planning and development, business management and general administrative activities.
- We may disclose your PHI without your consent as required by law.
- Disclosure to your group health plan’s Plan Sponsor. The Trust will also disclose PHI to the Plan Sponsor of your group health plan for purposes related to treatment, payment, and health care operations, if the Plan Sponsor has adopted amendments to its Plan Documents to permit this use and disclosure as required by federal law. For example, the Trust may disclose information to the Plan Sponsor to allow it to decide an appeal or review of an eligibility question or a subrogation claim.
When Does the Disclosure of Your PHI Require Your Written Authorization?
Except as otherwise indicated in this Notice, uses and disclosures will be made only with your written authorization subject to your right to revoke your authorization. Your written authorization will be required for any disclosure of your health information that involves marketing, the sale of your health information, or any disclosure involving direct or indirect remuneration to SEIU Healthcare NW Health Benefits Trust. Also, your written authorization generally will be required before SEIU Healthcare NW Health Benefits Trust will use or disclose psychotherapy notes, substance use disorder (SUD) records and SUD counseling notes.
- Psychotherapy notes are notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the patient’s medical record. Psychotherapy notes do not include any information about medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, or results of clinical tests; nor do they include summaries of diagnosis, functional status, treatment plan, symptoms, prognosis and progress to date. Psychotherapy notes also do not include any information that is maintained in a patient’s medical record.
- Substance Use Disorder (SUD) records refer to documentation related to the diagnosis, treatment or referral for treatment of substance use disorders.
- SUD counseling notes are notes recorded by a SUD or mental health professional during a SUD counseling session and that are separated from the rest of the patient’s record.
SEIU Healthcare NW Health Benefits Trust may use and disclose psychotherapy notes when needed to defend against litigation filed by you or as necessary to conduct treatment, payment and health care operations. Additionally, allowable disclosures without consent for psychotherapy notes include mandatory reporting of abuse or neglect, duty to warn situations where you pose a serious and imminent threat to yourself or others, and compliance with court orders.
SUD records and SUD counseling notes require written consent for most uses and disclosures, including those for treatment, payment and health care operations. You can provide a single consent for all future uses and disclosures of your SUD records for treatment, payment and health care operations. This single consent must be a separate document from any consent for use in civil or criminal proceedings. Consent may be revoked at any time. Providers must obtain separate written consent to use or disclose your SUD counseling notes, and they cannot be used or disclosed based on a broad consent for treatment, payment and health care operation.
Disclosure of SUD records without your consent is only permissible under specific conditions, such as a valid court order. Records are also protected from being used in civil, criminal, administrative and legislative proceedings without your consent unless mandated by a court.
In emergency situations, SUD information may be disclosed without consent if necessary to prevent a serious and imminent threat to health or safety. De-identified SUD records may also be disclosed to public health authorities or for research purposes without consent, ensuring privacy while supporting public health initiatives.
When Is the Use or Disclosure of My PHI Permitted and My Consent, Authorization or Opportunity to Object Is Not Required?
The Trust is allowed under federal law to use and disclose your PHI without your consent or authorization under the following circumstances:
- When required by applicable law.
- Public Interest, Health and Benefit Activities.
- Domestic violence or abuse situations.
- Health oversight activities.
- Legal proceedings.
- Law enforcement health purposes.
- Law enforcement emergency purposes.
- Determining cause of death and organ donation.
- Funeral purposes.
- Research.
- Health or safety threats.
- Incidental Disclosures.
- Workers’ compensation programs.
Are there Other Uses or Disclosures?
The Trust may contact you to provide you information about treatment alternatives or other health-related benefits and services that may be of interest to you.
The Trust may disclose protected health information to your group health plan sponsor for reviewing your appeal of a benefit claim or for other reasons regarding the administration of the Trust or your employer’s group health plan.
Your Individual Privacy Rights
Can I Request Restrictions on Uses and Disclosures of my PHI?
You may request the Trust to:
- Restrict the uses and disclosures of your PHI to carry out treatment, payment or health care operations.
- Restrict uses and disclosures to family members, relatives, friends or other persons identified by you who are involved in your care.
- Restrict disclosure of your health information to someone involved in payment for your care. SEIU Healthcare NW Health Benefits Trust is not required to agree to your request unless the disclosure relates to payment or health care operations and pertains to a health care item or service for which you have paid out of pocket in full.
The Trust is not required to agree to your request if the Trust determines your request to be unreasonable.
Make such requests in writing to The Trust Privacy Contact Person.
Phone: 206-254-7120
Address: 215 Columbia Street, Ste. 300 Seattle, WA 98104
Can I Request Confidential Communications?
The Trust will accommodate an individual’s reasonable request to receive communications of PHI by alternative means or at alternative locations where the request includes a statement that disclosure could endanger the individual.
You or your personal representative will be required to complete a form to request restrictions on uses and disclosures of your PHI. Make such requests to the Privacy Contact Person at the address above.
Can I Review and Request A Copy of My PHI?
You have a right to review and obtain a copy of your PHI for as long as the Trust maintains the PHI.
The Trust must provide the requested information within 30 days if the information is maintained on site or within 60 days if the information is maintained offsite. A single 30-day extension is allowed if the Trust is unable to comply with the deadline.
You or your personal representative will be required to complete a form to request access to the PHI. A reasonable fee may be charged. Requests for access to PHI should be made to the Privacy Contact Person.
If access is denied, you or your personal representative will be provided with a written denial setting forth the basis for the denial, a description of how you may exercise your review rights and a description of how you may complain to the Plan and HHS.
Do I Have the Right to Amend My PHI?
You have the right to request that the Trust amend your PHI or a record about you for as long as the PHI is maintained, subject to certain exceptions.
The Trust has 60 days after receiving your request to act on it. The Trust is allowed a single 30-day extension if the Trust is unable to comply with the 60-day deadline. If the Trust denied your request in whole or part, the Trust must provide you with a written denial that explains the basis for the decision. You or your personal representative may then submit a written statement disagreeing with the denial and have that statement included with any future disclosures of that PHI.
You should make your request to amend PHI to the Privacy Contact Person.
You or your personal representative will be required to complete a written form to amendment of the PHI and include a reason to support the requested amendment.
Do I Have the Right to Receive an Accounting of the Trust’s Disclosures of My PHI?
At your request, the Trust will also provide you with an accounting of certain disclosures by the Trust of your PHI. The Trust is not required to provide you with an accounting of disclosures related to treatment, payment, or health care operations, or disclosures made to you or authorized by you in writing. The Trust will respond to you upon your request and will notify if there is a delay in providing you with the information. The Trust may charge a reasonable fee if you make more than one request within a 12-month period.
Do I Have the Right to Receive a Paper Copy of This Notice Upon Request?
Yes. To obtain a paper copy of this Notice, contact the Privacy Contact Person, listed above.
Can My Personal Representative Act On My Behalf Regarding My Privacy Rights?
You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of authority to act on your behalf before the personal representative will be given access to your PHI or be allowed to take any action for you. Proof of such authority will be a completed, signed and approved Appointment of Personal Representative form. You may obtain this form by calling the Trust Administration Office.
The Trust retains discretion to deny access to your PHI to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.
The Trust will recognize certain individuals as personal representatives without you having to complete an Appointment of Personal Representative form. For example, the Trust will automatically consider a spouse to be the personal representative of an individual covered by a group health plan. In addition, the Trust will consider a parent or guardian as the personal representative of an unemancipated minor unless applicable law requires otherwise. 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 Trust restrict information that goes to family members.
Do I have a Right to opt out of Fundraising Communications?
You may opt-out of any marketing communications provided by the SEIU Healthcare NW Health Benefits Trust. To opt-out simply click the unsubscribe link included in the relevant e-mail communication, or contact us at mrc@myseiubenefits.org.
Disclosures
When using or disclosing PHI or when requesting PHI from another covered entity, the Trust 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.
In addition, the Trust may use or disclose “summary health information” to your group health plan’s Plan Sponsor 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 for whom a Plan Sponsor has provided health benefits under a group health plan. Identifying information will be deleted from summary health information, in accordance with HIPAA.
SEIU Healthcare NW Health Benefits Trust is prohibited by law from using or disclosing genetic health information for underwriting purposes.
Your Right to File a Complaint with the Trust or the HHS Secretary
If you believe that your privacy rights have been violated, you may file a complaint with SEIU Healthcare NW Health Benefits Trust as indicated below.
You may also file a complaint with:
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
Email: OCRComplaint@hhs.gov
The Trust will not retaliate against you for filing a complaint.
If You Need More Information
If you have any questions regarding this notice or the subjects addressed in it, you may contact us.
Phone: 206-254-7120
Address: 215 Columbia Street, Ste. 300 Seattle, WA 98104
