Privacy Health Insurance Market

Privacy Health Insurance Market

Privacy Health Insurance Market

PRIVACY STATEMENT FOR PROTECTING PERSONALLY IDENTIFIABLE INFORMATION (PII) COLLECTED BY A CERTIFIED APPLICATION COUNSELOR DESIGNATED ORGANIZATION

THIS NOTICE DESCRIBES HOW PERSONALLY IDENTIFIABLE INFORMATION (PII) ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this notice please contact our Privacy Officer at 954-473-7500 or toll free by calling 1.855.209.5295.

ABOUT THIS NOTICE

Certain information collected by Broward Health for the purposes of participating in the operation of a Federally-facilitated Exchange (FFE) is referred to as Personally Identifiable Information (PII). PII includes such things as your name, address, and other identifying data, as well your gender and any languages you speak. This information will be collected and used to help determine eligibility for your enrollment into a Qualified Health Plan (QHP) in the Health Insurance Marketplace (HIM). This statement describes the privacy practices for information collected from you during the HIM enrollment process. This privacy statement applies to the PII about you that is maintained by Broward Health for this program, including any such information that is maintained on paper, electronically, or verbally spoken. This PII statement serves to tell you how Broward Health may use and disclose the information that has been collected and what rights you have with respect to your PII.

WHO WILL FOLLOW THIS STATEMENT

The information in this statement describes the privacy practices of Broward Health and applies to:

  • Any Broward Health Workforce Member certified to act as Certified Application Counselors (CACs) for the HIM.
  • The information in this notice also applies to the following health care providers owned and operated by Broward Health:

Broward Health regional hospitals and Broward Health primary care facilities.

HOW WE MAY USE OR DISCLOSE YOUR PERSONALLY IDENTIFIABLE INFORMATION (PII)

Broward Health may create, collect, disclose access, maintain, store, and use your PII in order to:

a. Provide information to you about the full range of QHP options and/or Insurance Affordability Programs for which you are eligible, which includes: providing fair, impartial, and accurate information that assists you with submitting the HIM application; clarifying the distinctions among health coverage options, including QHPs; and helping you make informed decisions during the health coverage selection process;
b. Assist you with enrollment application for coverage in a QHP through the FFE and/or Insurance Affordability Programs. Your PII would be disclosed to the HIM for this purpose;
c. Help to facilitate your enrollment into a QHP and/or Insurance Affordability Program;
d. Perform other functions related to carrying out additional obligations as may be required under applicable state law or regulation, provided that (1) such a state requirement does not prevent the application of the provisions of Title I of the Affordable Care Act within the meaning of section 1321 of the Affordable Care Act, and (2) Broward Health notifies you in advance, in writing, that collection, handling, disclosure, access maintenance, storage, and/or use of their PII might be required under applicable state law or regulations.
e. Perform other functions, including functions substantially similar to those stated above, and such other functions that may be approved by the U.S. Centers for Medicare and Medicaid Services (CMS) in writing from time to time.

PII WE MAY COLLECT FROM YOU

Broward Health may create, collect, disclose access, maintain, store, and use the following data and PII from you, including but not limited to:

Access to or enrollment in employer or other health coverage
American Indian/Alaska Native status
APTC percentage and amount applied
Auto disenrollment information
Applicant Name
Applicant Address
Applicant Birthdate
Applicant Telephone number
Applicant Email
Applicant spoken and written language preference
Applicant Medicaid Eligibility indicator, start and end dates
Applicant Children’s Health Insurance Program eligibility indicator, start and end dates
Applicant QHP eligibility indicator, start and end dates
Applicant APTC percentage and amount applied eligibility indicator, start and end dates
Applicant household income
Applicant Maximum APTC amount
Applicant Cost-sharing Reduction (CSR) eligibility indicator, start and end dates
Applicant CSR level
Applicant QHP eligibility status change
Applicant APTC eligibility status change
Applicant CSR eligibility status change
Applicant Initial or Annual Open Enrollment Indicator, start and end dates
Applicant Special Enrollment Period eligibility indicator and reason code
Citizenship status
Contact Name
Contact Address
Contact Birthdate
Contact Telephone number
Contact Email
Contact spoken and written language preference
Enrollment group history (past six months)
Enrollment type period
FFE Applicant ID
FFE Member ID
Gender
Immigration document type and document numbers
Issuer Member ID
Membership in a Federally-recognized tribe
Net premium amount
Premium Amount, start and end dates
Pregnancy indicator
Race/ethnicity
Sex
Special enrollment period reason
Subscriber Indicator and relationship to subscriber
Social Security Number
Tax filing status (tax filer, tax dependent, non-filer)
Tobacco use indicator and last date of tobacco

AUTHORIZATION

Prior to creating, collecting, disclosing, accessing, maintaining, storing, or using any of your PII, Broward Health will ensure that the CAC obtains the authorization required by the HIM and will permit the authorization to be revoked at any time. This authorization is separate and distinct from any informed consent obtained by Broward Health for any treatment purposes. Your PII will not be shared without authorization or consent.

Broward Health is permitted to use and disclose your PII in accordance with federal and state regulations. There are Federal regulations which safeguard the privacy and security of your PII and establish certain rights with respect to your PII. At times, State or other regulations may afford more protection or provide additional patient rights that exceed the regulations outlined under the Federal regulations. In these and all other applicable cases, Broward Health will abide by the most stringent of the regulations as they pertain to PII, including obtaining your prior written authorization, as required, before any such information is disclosed to a third party.

PII collected from you is mandatory to be considered for enrollment into the HIM. Required PII not supplied by you will make you ineligible for enrollment in the HIM.

SPECIAL SITUATIONS: HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR CONSENT, AUTHORIZATION, OR OPPORTUNITY TO AGREE OR OBJECT VERBALLY

Under certain circumstances, Broward Health may use or disclose your PII without your authorization or any other type of permission from you. These circumstances are as follows:
As Required By Law. We will disclose PII about you when required to do so by international, federal, state, or local law.

SAFEGUARDING YOUR PII

It is the policy of Broward Health to implement reasonable administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and availability of the PII that it creates, receives, maintains, or transmits.
Broward Health has implemented:
Administrative safeguards such as policies and procedures designed to manage the conduct of its workforce in relation to the protection of PII and other sensitive information and to manage the selection, development, implementation, and maintenance of security measures.
Physical safeguards such as policies and procedures relating to the system-wide implementation of physical access controls to protect the physical environment where your PII is housed.
Technical safeguards such as the use of auto-logoff, encryption/decryption, and secure modes of transmission to ensure the protection of PII.

Broward Health will ensure your PII:
is only used by or disclosed to those authorized to receive or view it;
is protected against any reasonably anticipated threats or hazards to the confidentiality, integrity, and availability of such information;
is protected against any reasonably anticipated uses or disclosures of such information that are not permitted or required by law; and
is securely destroyed or disposed of in an appropriate and reasonable manner and in accordance with record retention requirements under the agreement Broward Health has signed for the administration of this program.

YOUR RIGHTS REGARDING YOUR PII

You have the following rights, subject to certain limitations, regarding your PII:


Right to Request Restrictions. You have the right to ask Broward Health to limit the PII we use or disclose about you for possible enrollment in a QHP. Your request must state the specific restriction requested and to whom you want the restriction to apply.
The Right to Access. You have the right to access to the PII we collect for purposes of enrolling you into a QHP. Broward Health will make every reasonable attempt to provide you with access to your PII within thirty (30) days of your request.
Right to Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is the list of disclosures we made of your PII for reasons other than carrying out the authorized functions for enrollment in a QHP.

The Accounting of Disclosures will:


Include the date, nature, and purpose of such disclosures, and the name and address of the person or agency to whom the disclosure is made;
Be retained for at least six (6) years after the disclosure, or the life of the record, whichever is longer;
Be available to the U.S. Centers for Medicare and Medicaid Services (CMS) or you upon request.

Requests for an Accounting of Disclosures can be made to Broward Health’s Privacy Officer at 954.473.7500 or toll free at 1.855.209.5295. You may also request an Accounting of Disclosures in writing to:
Broward Health
Corporate Compliance Department
Attn: Privacy Officer
1800 NW 49th Street
Fort Lauderdale, FL 33309

Paper Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time, even if you agreed to receive this notice, electronically. If you have obtained this notice electronically, you may obtain a paper copy by asking a Broward Health Patient Financial Counselor/Certified Application Counselor or by contacting Broward Health’s Privacy Officer at (954) 473-7500. You may also print a copy from our website at: www.browardhealth.org/pages/privacy-healthinsurancemarket.

HOW TO EXERCISE YOUR RIGHTS

To exercise any of your rights described in this notice, please send your request, in writing, to Broward Health’s Privacy Officer at the address listed below. We may ask that you fill out a form that we will provide to you or to contact the region/facility directly where you received services.

Broward Health, Corporate Compliance Department
Attn: Privacy Officer
1800 NW 49th Street
Fort Lauderdale, FL 33309

FOREIGN LANGUAGE VERSION

If you have difficulty reading or understanding English, you may ask to receive a copy of this notice in Spanish, Creole, French or Portuguese. Additional languages or formats will be made available upon request.

PRIVACY COMPLAINTS

If you believe your privacy or any of your rights as described in this notice have been violated, you may file a complaint with Broward Health, the U.S. Department of Health and Human Services, Office for Civil Rights or Centers and/or the U.S. Center for Medicare and Medicaid Services. To file with Broward Health, please contact Broward Health’s Privacy Officer at 954.473.7500 or toll free at 1.855.209.5295. You may also file your privacy complaint with Broward Health by submitting your written complaint to:

Broward Health
Corporate Compliance Department
Attn: Privacy Officer
1800 NW 49th Street
Fort Lauderdale, FL 33309

To file a complaint with the U.S. Department of Health and Human Services, you may call toll free 1.800.368.1019 or visit the website of the Office for Civil Rights at www.hhs.gov/ocr. You can also mail a written request to:
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

To file a complaint with the U.S. Department of Health and Human Services, you may call toll free 1.800.633.4227 or visit the website of the U.S. Centers for Medicare and Medicaid Services (CMS) Office for Civil Rights at www.cms.gov. You can also mail a written request to:
U.S. Centers for Medicare and Medicaid Services (CMS)
U.S. Department of Health and Human Services
7500 Security Boulevard
Baltimore, MD 21244
1-800-MEDICARE (1-800-633-4227)
You will not be retaliated against for filing a complaint.

Broward Health may not threaten, intimidate, coerce, harass, discriminate against, or take any other retaliatory action against any individual or other person for filing a complaint.