Health Benefit Fund
Message from Fund Director Dorothy Siniscalchi:
IMPORTANT MESSAGE TO MEMBERSHIP & PARTICIPANTS/RETIREES AND DEPENDENTS
UPDATE: HARTFORD HEALTHCARE FACILITIES AND PHYSICIANS AGREEMENT WITH ANTHEM IS SETTLED EFFECTIVE OCTOBER 1, 2014
Hartford Healthcare and physicians (HHC), and Anthem, have reached a multi-year agreement with a retroactive effective date of October 1, 2014. Covered services provided by HHC on October 1, 2014 and subsequent will be considered “in network” without interruption. This arrangement applies to all of the related organizations that have been previously listed on this webpage.
We would like to thank all members/retirees and participants for their patience with this matter as it is our ultimate goal to see that we have the best providers available to you at all times. If you have further questions please do not hesitate to contact the Health Fund Office.
International Union of
Local 478 No. Health Benefits Fund
of the Fund’s Privacy Practices
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.
1: Purpose of This Notice and Effective Date
Effective date. The initial effective date of this
Notice was April 14, 2003. This 2013 Restatement is effective as of September 23, 2013, and it
reflects a number of recent changes in a federal law known as the Health Insurance Portability and
Accountability Act of 1996, as amended (HIPAA).
Notice is required by law. The International Union of Operating Engineers Local No. 478 Health Benefits
Fund (Fund) is required by law to take reasonable steps to ensure the privacy of your personally
identifiable health information and to inform you about:
• The Fund’s uses and
disclosures of Protected Health Information or “PHI,” defined in Section 2, A,
rights to privacy with respect to your PHI,
• The Fund’s duties with respect to your
• Your right to file a complaint with the Fund and with the Secretary of the United
States Department of Health and Human Services (HHS), and
• The person or office you
should contact for further information about the Fund’s privacy practices.
2: Your Protected Health Information
A. Protected Health Information Defined
term “Protected Health Information” or “PHI” includes all individually
identifiable health information relating to your past, present or future physical or mental health
condition or to payment for health care. PHI includes information maintained by the Fund in oral,
written, or electronic form.
the Fund May Disclose Your PHI
Under the law, the Fund may disclose your PHI without your consent or
authorization, and without providing you an opportunity to agree or object, in the following cases:
treatment, payment or health care operations. The Fund and its business associates will use PHI in order
to carry out your treatment, the payment of your benefits, or its health care operations:
is the provision, coordination, or management of health care and related services. It also
includes consultations and referrals between one or more of your providers.
▪ For example,
your doctor or hospital may contact the Fund’s employee assistance program to request
authorization for certain medical treatment.
→ Payment includes actions to make coverage
determinations and payment (including billing, claims management, reimbursement, reviews for medical
necessity and appropriateness of care and utilization review and preauthorizations).
example, the Fund may tell a doctor whether you are eligible for coverage or what percentage of the bill
will be paid by the Fund. If we contract with third parties to help us with these operations, such
as companies that administer health plans or reprice claims to take advantage of discounts (e.g.,
Anthem), we will also disclose information to them. These third parties are known as “business
→ Health care operations includes quality assessment
and improvement, reviewing competence or qualifications of health care professionals, underwriting,
premium rating and other activities relating to creating or renewing insurance contracts. Please
note that if the Fund uses or discloses PHI for underwriting purposes, it is prohibited from using or
disclosing PHI that is genetic information of an individual for such purposes. Health care
operations also includes disease management, case management, conducting or arranging for medical
review, legal services, and auditing functions including fraud and abuse compliance programs, business
planning and development, business management and general administrative activities.
example, the Fund may use information about your claims to refer you into a disease management program,
to refer your spouse to a well-pregnancy program, to project future benefit costs or audit the accuracy
of its claims processing functions. In no event will the Fund use or disclose any of your genetic
• Disclosure to the Fund’s Trustees. The Fund will also
disclose PHI to the Fund’s Board of Trustees for purposes related to treatment, payment, and
health care operations, and the Board of Trustees has amended the Fund’s Trust Agreement to permit
this use and disclosure as required by federal law.
▪ For example, the Fund may disclose
information to the Board of Trustees to allow them to decide an appeal or review a reimbursement matter.
For your information, the Fund attempts to keep all appeals or requests to change the terms of the Fund’s
• When required by applicable law. The Fund will disclose PHI
when required to do so by any federal, state or local law.
• Public health purposes. The
Fund will disclose PHI to an authorized public health authority if required by law or for public health
and safety purposes. PHI may also be used or disclosed if you have been exposed to a communicable
disease or are at risk of spreading a disease or condition, if authorized by law. In addition, PHI
may be disclosed to an appropriate government agency authorized to receive reports of child abuse or
• Domestic violence or abuse situations. The Fund will disclose PHI when
authorized by law to report to public authorities information about abuse, neglect or domestic violence
if a reasonable belief exists that you may be a victim of abuse, neglect or domestic violence and the
Fund believes the disclosure is necessary to prevent serious harm to you or other potential victims. In
such case, the Fund will promptly inform you that such a disclosure has been or will be made unless that
disclosure would cause a risk of serious harm.
• Health oversight activities. The Fund
will disclose PHI to a health oversight agency for oversight activities authorized by law. These
activities include civil, administrative or criminal investigations, inspections, licensure or
disciplinary actions (for example, to investigate complaints against health care providers) and other
activities necessary for appropriate oversight of government benefit programs (for example, to the
Departments of Labor or Health and Human Services).
• Legal proceedings. The Fund will
disclose PHI when required for judicial or administrative proceedings. For example, your PHI may be
disclosed in response to a subpoena or discovery request that is accompanied by a court order, or if the
Fund receives a National Medical Support Notice in connection with covering a child of yours.
enforcement health purposes. The Fund will disclose PHI when required for law enforcement purposes (for
example, to report certain types of wounds).
• Law enforcement emergency purposes. The
Fund will disclose PHI for certain law enforcement purposes, including:
→ identifying or
locating a suspect, fugitive, material witness or missing person, and
information about an individual who is or is suspected to be a victim of a crime.
cause of death and organ donation. The Fund may give PHI to a coroner or medical examiner to identify a
deceased person, determine a cause of death or other authorized duties. We may also disclose PHI
for cadaveric organ, eye or tissue donation purposes.
• Funeral purposes. The Fund may
give PHI to funeral directors as necessary to carry out their duties with respect to the decedent.
The Fund will disclose PHI for research, provided certain strict conditions are met.
or safety threats. The Fund will disclose PHI when, consistent with applicable law and standards of
ethical conduct, the Fund in good faith believes the use or disclosure is necessary to prevent or lessen
a serious and imminent threat to the health or safety of a person or the public and the disclosure is to
a person reasonably able to prevent or lessen the threat, including the target of the threat.
compensation programs. The Fund will disclose PHI when authorized by and to the extent necessary to
comply with workers’ compensation or other similar programs established by law.
the Disclosure of Your PHI Requires 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. You may make a written revocation of your authorization on a
prospective basis at any time. Here are a few examples:
to Other Benefit Funds. On certain occasions, the International Union of Operating Engineers Local
No. 478 Pension Fund (Pension Fund) may need to receive information from this Fund, for example if you
are determined to be disabled by the Social Security Administration. In those cases, we will
request an authorization from you to release such information in order to enable the Pension Fund to
process your application for retirement benefits.
• Psychotherapy notes are separately
filed notes about your conversations with your mental health professional during a counseling session.
They do not include summary information about your mental health treatment or medications prescribed to
you. Although the Fund does not routinely obtain psychotherapy notes, it must generally obtain
your written authorization before the Fund will use or disclose psychotherapy notes about you other than
for treatment, payment or health care operations. However, the Fund may use and disclose such
notes when needed by the Fund to defend itself against litigation filed by you.
purposes. The Fund will request authorization for any use or disclosure of PHI for marketing,
except in situations involving a face to face communication or a promotional gift of nominal value.
The Fund is not in the business of marketing PHI, and it does not expect to do so in the future.
of PHI. The Fund will request authorization for any disclosure of PHI which constitutes a sale of
PHI. The Fund is not in the business of selling PHI, and it does not expect to do so in the future
or Disclosure of Your PHI That Requires You Be Given an Opportunity to Agree or Disagree Before the Use
• Disclosure of your PHI to family members, other relatives and your close
personal friends is allowed under federal law if:
→ The information is directly relevant
to the family or friend’s involvement with your care or payment for that care, and
have either agreed to the disclosure or have been given an opportunity to object and have not objected.
• You should note that under certain circumstances described earlier, federal law allows
the use and disclosure of your PHI without your consent, authorization or opportunity to object to such
use or disclosure.
• There are also restrictions on PHI involving fundraising activities,
but the Fund has never engaged in such activities. In the unlikely event the Fund engages in
fundraising in the future, any fundraising communications you receive will contain a description of how
to opt out of receiving such communications.
3: Your Individual Privacy Rights
The following is a description of your individual privacy
rights. It is important to note that while all requests should be directed to the Fund, the Fund
contracts with numerous vendors, also called “business associates,” who provide services to
the Fund and services and benefits to you on the Fund’s behalf. Once the Fund is notified
that you choose to invoke any of the individual rights listed below, it will respond or notify the
appropriate vendor, as applicable, on your behalf. Because some of your PHI is maintained and used
by these business associates to provide or process your benefits, the Fund requires that they administer
certain aspects of the individual privacy rights.
exercise any of the following rights, you must contact the Privacy Official, whose contact information
is located in Section 6, to receive the appropriate form which you must complete in full and submit to
the Privacy Official.
May Request Restrictions on PHI Uses and Disclosures
You may request the Fund to:
the uses and disclosures of your PHI to carry out treatment, payment or health care operations, or
uses and disclosures to family members, relatives, friends or other persons identified by you who are
involved in your care.
however, is not required to agree to your request.
May Request Confidential Communications
The Fund 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 will have to
indicate the requested alternative means and/or locations on the form you request from and submit to the
May Inspect and Copy PHI
You have a right to inspect and obtain a copy of your PHI contained in
a “designated record set” (defined below), in hardcopy or electronic form, as long as the
Fund maintains the PHI. However, you do not have a right to inspect or copy psychotherapy notes;
information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative
action or proceeding; or PHI that is subject to law(s) that otherwise prohibits access to PHI. The
Fund must provide the requested information within 30 days if the information is maintained on site or
within 60 days if the information is maintained off-site. A single 30-day extension is allowed if the
Fund 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 in your designated record set. A reasonable fee
may be charged. Requests for access to PHI should be made to the Privacy Official, whose contact
information is in Section 6.
limited circumstances, access may be denied. 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
Fund and HHS.
term “designated record set” includes your medical records and billing records that are
maintained by or for a covered health care provider. Records include enrollment, payment, billing,
claims adjudication and case or medical management record systems maintained by or for a health plan or
other information used in whole or in part by or for the covered entity to make decisions about you.
Information used for quality control or peer review analyses and not used to make decisions about you is
Have the Right to Amend Your PHI
You have the right to request that the Fund amend your PHI or a
record about you in a designated record set for as long as the PHI is maintained by the Fund in the
designated record set subject to certain exceptions.
has 60 days after receiving your request to act on it. The Fund is allowed a single 30-day
extension if the Fund is unable to comply with the 60-day deadline. If the Fund denies your
request in whole or part, the Fund 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 your PHI. You
should make your request to amend PHI to the Privacy Official. See Section 6, below, for more
Have the Right to Receive an Accounting of the Fund’s PHI Disclosures
At your request, the
Fund will also provide you with an accounting of certain disclosures by the Fund of your PHI. We
do not have 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.
has 60 days to provide the accounting. The Fund is allowed a single 30-day extension if the Fund
gives you a written statement of the reasons for the delay and the date by which the accounting will be
provided. Also, if you request more than one accounting within a 12-month period, the Fund may
charge a reasonable, cost-based fee for each subsequent accounting. You should make your request
for an accounting of the Fund’s disclosures of your PHI to the Privacy Official. See Section
6, below, for more information.
Right to a Paper Copy of this Notice
You have a right to request and receive a paper copy of this
Notice at any time, even if you have received the Notice previously or agreed to receive the Notice
electronically. Your request to receive a paper copy of the Notice must be made in writing to the
Privacy Official, whose contact information is in Section 6.
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 which you may obtain from the Privacy Official.
retains the right to deny access to your PHI to a personal representative in the following situation.
If the Fund has a reasonable belief that: (1) you have been or may be subjected to domestic abuse,
violence or neglect by such person or treating such person as your personal representative could
endanger you, and (2) the Fund, in its exercise of professional judgment, decides that it is not in your
best interest to treat the individual as your representative.
will recognize certain individuals as personal representatives without you having to complete an
Appointment of Personal Representative form. For example, absent notice of any restrictions to the
contrary, the Fund will automatically consider a spouse to be the personal representative of an
individual covered by the Fund. In addition, the Fund will consider a parent, guardian or other
person acting in loco parentis as the personal representative of an unemancipated minor unless
applicable law requires otherwise. A spouse or a minor’s parent may act on an individual’s
behalf, including requesting access to his or her PHI. Spouses and unemancipated minors may,
however, request that the Fund restrict access of PHI to family members as described in Section 3, A of
have any questions about the circumstance under which the Fund will automatically consider an individual
to be your personal representative, contact the Privacy Official and ask for a copy of the Fund’s
Policy and Procedure for the Recognition of Personal Representatives.
4: The Fund’s Duties
A. Maintaining Your Privacy; Providing You a Notice of its
The Fund is required by law to maintain the privacy of your PHI and to provide you
and your eligible dependents with notice of its legal duties and privacy practices with respect to PHI.
The Fund is now required to notify you of anything that the law defines as a breach of your unsecured
PHI, and you have a right to, and will receive, appropriate notifications in the event of any such
Notice was initially effective on April 14, 2003, and this restatement is effective as of September 23,
2013. The Fund is required to comply with the terms of this Notice. However, the Fund reserves the
right to change its privacy practices and to apply the changes to any PHI received or maintained by the
Fund prior to the effective date of this Notice. If a privacy practice is changed, a revised version of
this Notice will be provided to you and to all other individuals required by law. Any revised
Notice of Privacy Practices will be sent by U.S. Mail, and it will be distributed within 60 days of the
effective date of any material change to: (1) the uses or disclosures of PHI, (2) your individual
rights, (3) the duties of the Fund, or (4) other privacy practices stated in this Notice.
Only the Minimum Necessary Protected Health Information
When using or disclosing PHI or when
requesting PHI from another covered entity, the Fund 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. However,
the minimum necessary standard will not apply in the following situations:
to or requests by a health care provider for treatment,
• Uses or disclosures made to you,
• Uses or disclosures made pursuant to your authorization,
made to the Secretary of HHS pursuant to its enforcement activities under HIPAA,
• Uses or
disclosures required by law, and
• Uses or disclosures required for the Fund’s
compliance with the HIPAA privacy regulations.
Notice does not apply to information that has been de-identified. De-identified information is
• Does not identify you, and
• Cannot reasonably be
expected to identify you.
addition, the Fund may use or disclose “summary health information” to the Fund’s
Board of Trustees for purposes of obtaining cost bids or modifying, amending or terminating the Fund’s
group health plan. Summary information summarizes the claims history, claims expenses or type of claims
experienced by individuals for whom the Fund’s Board of Trustees has provided health benefits
under the Fund’s group health plan. Identifying information will be deleted from summary health
information, in accordance with HIPAA.
5: Your Right to File a Complaint with the Fund or the Office of Civil Rights
If you believe
that your privacy rights have been violated, you may file a written complaint with the Fund in care of
the Privacy Official at the address listed in Section 6, immediately below. You may also file a
complaint with the Office of Civil Rights for Connecticut’s Region, which as of the date this
Notice was prepared was:
Peter Chan, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human
JFK Federal Building – Room 1875
Boston, MA 02203
(800) 368-1019 or (800) 537-7697 (TDD)
FAX: (617) 565-3809
Fund will not retaliate against you for filing a complaint.
6: If You Need More Information
If you have any questions regarding this Notice or the subjects
addressed in it, you may contact the following official at the Fund Office:
I.U.O.E. Local No. 478 Health Benefits Fund
1965 Dixwell Avenue
PHONE: (203) 288-9261 / TOLL FREE: (866) 288-9261
FAX: (203) 281-3894
As outlined in Section I, PHI use and disclosure by the Fund is regulated by
HIPAA, as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act of
2009. You may find these rules at Parts 160 and 164 of Title 45 of the Code of Federal
Regulations. This Notice attempts to summarize those regulations and notify you of your rights.
The regulations will prevail if there is any discrepancy between the information in this Notice and the
If you are an Active Member or
Retired Member of Local 478 and meet the Plan™ eligibility rules, you have excellent in-network
medical benefits through an arrangement with Anthem Blue Cross and Blue Shield. You have comprehensive
dental, behavioral health, prescription drug and vision coverage through various specialty networks.
Because our Plan utilizes the Anthem BCBS Network, you have access to their website, which has a variety
of tools to help you manage your health. All you have to do is go to their website www.anthem.com
register in the top right hand corner
and select a username and password.
manage our costs to provide a high level of benefits primarily through discount agreements with network
providers. With the exception of behavioral health and prescription drugs, you can usually make an
appointment with an in-network practitioner without prior approval. The current co-pay for most
in-network physician visits is $25, regardless of the amount the physician charges. Out-of-network
medical benefits are available on an 80/20 basis after you satisfy an annual $200 deductible.
Active member benefits
Important: This is intended to be a brief
description of benefits offered under the IUOE Local 478 Health Benefit Funds. The actual terms of
the plan description will govern any specific situation.