HIPAA Notice of Privacy Practices for Personal Health Information

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 Will Become Effective on April 14, 2004

This Notice of Privacy Practices from Life Insurance Company of the Southwest (LSW) relates to the health information we have about you as a result of your medical or cancer plan coverage. This information is called "Protected Health Information" or "PHI", and it includes individually identifiable information that relates to your past, present or future physical condition and related health care services. This notice describes how we protect the privacy of your PHI, explains how we may use and disclose PHI, and also describes your rights with respect to you PHI and how you can exercise those rights.

We are required to provide this notice of our legal duties and privacy practices with respect to your PHI by the Health Insurance Portability and Accountability Act (HIPAA). We are also required to maintain the privacy of your PHI, and follow the terms of this notice.

We reserve the right to change the terms of this Notice at any time and to make the revised or change Notice effective for PHI we already have about you, as well as PHI we receive in the future. If the terms of this Notice materially change, you will receive a copy of the revised Notice from LSW.

Use and Disclosure of Your PHI

LSW takes steps to protect your PHI from inappropriate use or disclosure. LSW employees are required to comply with these privacy practices. They may look at your PHI only when there is an appropriate or legal reason to do so.

Your Authorization

Except as described in this Notice, LSW will not disclose your personal health information without your written authorization. You may revoke your authorization in writing at any time. If you revoke your authorization, LSW will no longer use or disclose your health information for the reasons covered by your written authorization, except to the extent that LSW has taken action in reliance on the authorization.

Uses and Disclosures for Payment

LSW may use and disclose your personal health information as necessary for payment purposes. For example, LSW may use or disclose your health information to determine eligibility for benefits, to obtain premiums, or to process and pay claims.

Disclosures to Business Associates

At times it may be necessary for LSW to disclose your health information to outside persons or organizations that it contracts with to assist it with certain services. Each Business Associate of LSW must agree in writing to ensure the continuing confidentiality and security for your health information.

Other Uses and Disclosures

LSW may also use and disclose your PHI without authorization as follows:

• As required by law;
• For public health activities;
• About victims of abuse, neglect or domestic violence;
• For health oversight activities;
• For judicial and administrative proceedings;
• About decedents in limited circumstances, after your death;
• For cadaveric organ, eye or tissue donation purposes;
• For research purposes;
• To avert a serious threat to health or safety;
• For specialized government functions;
• For law enforcement purposes.

Your Rights

Right to Request Confidential Communications

You have the right to make a reasonable request to receive communication of PHI confidentially, by alternative means or at alternative locations.

Right to Inspect and Copy

You have the right to inspect and /or copy health information about you that may be used to make decisions about your plan benefits.

Right to Paper Copy

You have the right to receive a paper copy of this Notice of Privacy Practices at any time. You may also obtain a copy here.

Right to Accounting Disclosures

You have the right to receive a list of "accounting disclosures" in which we disclose your protected health information for purposes other than treatment, payment, health care operations and certain other activities. Your request should specify a time period of up to six years and may not include dates before April 14, 2004.

Right to Request Amendments

You have the right to request that LSW amend your health information that you believe is incorrect or incomplete. We may deny your request if it is not in writing or does not include a reason that supports the request. Your request may also be denied if you ask LSW to amend PHI that:

• Is correct and complete;
• Is not part of the PHI kept by or for us;
• Was not created by us;
• Is not part of the PHI which you would be permitted to see and copy

Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your health information. LSW is not required to agree to the restrictions that you request. However, LSW must adhere to any restrictions to which it agrees to make.

Exercising your Rights

If you want to exercise any of the right described in this Notice, please submit a written request to the Contact Office (below). LSW will provide you with the necessary information and forms for you to complete and return. In some cases, LSW may charge you a nominal, cost-based fee to carry out your request.

Complaints

If you believe your privacy rights have been violated by LSW, you have the right to complain to LSW or to the Secretary of the U.S. Department of Health and Human Services in Washington, D.C. LSW will not retaliate against you if you choose to file a complaint.

Contact Office

To request additional copies of this Notice or your rights, please contact:

HIPAA Compliance Contact
Life Insurance Company of the Southwest
1300 West Mockingbird Lane
Dallas, TX 75247-4921
Telephone: 800- 579-2878

Updated: Monday, December 03, 2007 11:43:04 PM  Eastern