THE CLAIRITY PROGRAM

Real Relief for Digestive Distress

Medical Privacy Statement

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.

The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal law that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. This Act gives you significant rights to understand and control how your health information is used. HIPAA provides penalties for covered entities that misuse personal health information.

As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information. We may disclose information orally, on paper, or electronically.

We may use and disclose your health information only for each of the following purposes: treatment, payment, health care operations and certain special situations.

  • Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would include case management.
  • Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be submission of a claim for payment for the Clairity program.
  • Health care operations include the business aspects of running our health care business, such as conducting quality assessment and improvement activities, auditing functions, cost management analysis, and customer service. An example would be an internal quality assessment review or acting as a business associate of a health plan.
  • Special Situations include disclosures for your safety or for the safety of the general public; to individuals involved in your care or payment for your care (unless you specifically object to such disclosures); for instances of national security; for worker’s compensation; for organ donation programs (if you are an organ donor); to military command (if you are a member of the armed services); to coroners, medical examiners or funeral directors; or as otherwise required by law.

We may also create and distribute deidentified health information by removing all references to individually identifiable information.

We may communicate with you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you; however, if we are receiving compensation for these communications, we must first obtain written authorization from you.

We may not use or disclose your genetic information for underwriting purposes. We may not transfer or sell your health information without your express written authorization, unless the transfer is part of a merger, transfer, or sale of the Clairity program to a new owner. Any other uses and disclosures will be made only with your written authorization. We have requested your authorization to disclose to your employer a roster of program participants, which contains identifiers such as name, employee identification number, date of birth and other demographic data and may in some cases include health-related eligibility criteria. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officer:

  • The right to inspect and copy your protected health information, either electronically or on paper, and obtain this copy within 30 days or within 60 days if we are unable to provide the information within 30 days and notify you of the delay within the first 30 days.
  • The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
  • The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are not, however, required to agree to a requested restriction, unless the request is made to restrict disclosure to an insurer or health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment), and the protected health information pertains solely to a health care item or service for which you have paid out of pocket in full.

If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.

  • The right to request an amendment of your protected health information. We are not required to agree to the requested amendment of your information, but will consider your request.
  • The right to receive an accounting of certain non-routine disclosures of protected health information that were not disclosed for treatment, payment or health care operations.
  • The right to obtain notice from us in the event that the privacy or security of your protected health information has been breached. We have the obligation to provide this information to you.
  • The right to opt out of any communications that may be construed as fundraising or marketing.
  • The right to receive a paper copy of this Notice of Privacy Practices from us upon request. We have the obligation to let you know about the availability of this Notice every three years.
  • In some cases, state laws will further limit the use or disclosure of information such as mental health, substance abuse, and HIV/AIDS and other types of health information, in which case we will adhere to the more restrictive state law. This Notice is effective as of March 2016 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. We will provide you with a copy of the revised Notice within 60 days of the change. You have recourse if you feel that your privacy protections have been violated. You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office for Civil Rights, about violations of the provisions of this Notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint.

    Please contact us for more information:

    Privacy Officer ACAP Health Consulting, LLC.
    12712 Park Central Drive, Suite 100
    Dallas, TX 75251
    Facsimile: (214) 346-4639

    For more information about HIPAA or to file a complaint:

    The U.S. Department of Health & Human Services Office for Civil Rights
    200 Independence Avenue, S.W.
    Washington, D.C. 20201
    (202) 619-0257
    Toll Free: 1-877-696-6775