HIPAA NOTICE OF PRIVACY PRACTICES

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 of Privacy Practices is required by the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. This notice describes the privacy practices of Delta Dental of Minnesota and its affiliates, including Delta Dental of Nebraska and Health Ventures Network (Collectively, “Delta Dental”, “we” or “our” or “us” or the “Plan”). These entities have designated themselves as a single affiliated covered entity for purposes of the privacy rules under HIPAA, and each has agreed to abide by the terms of this notice and may share protected health information with each other as necessary for treatment, payments or to carry out health care operations, or as otherwise permitted by law.

We understand that medical information about you and your health is personal, and we are committed to protecting your medical information. Individually identifiable information about your past, present or future health or condition, the provision of health care to you, or payment for such health care is considered “Protected Health Information” (“PHI”).

Our Permitted Uses and Disclosures of Your Protected Health Information are:

We use and disclose PHI about you for treatment, payment, and health care operations. These uses and disclosures are more fully described below. Please note that this Notice does not list every use or disclosure; instead it gives examples of the most common uses and disclosures.

Treatment: We may disclose PHI to your dentist(s) for treatment purposes. For example, your dentist may wish to provide a dental service to you but first seek information as to whether the service has been previously provided.

Payment: We disclose your PHI in order to fulfill our duty to provide your coverage, determine your benefits, and make payment for services provided to you. For example, we use your PHI in order to process your claims.

Health Care Operations: We disclose your PHI as a part of certain operations, such as quality improvement. For example, we may use your PHI to evaluate the quality of dental services that were performed.

We may be asked by the sponsor of your health plan to provide your PHI to the sponsor. If we are asked to do so, we intend to honor such requests unless we are prohibited by law from doing so.

We may use or disclose your PHI without your authorization for several other reasons. Subject to certain requirements, we may give out PHI without your authorization for public health purposes, auditing purposes, research studies, and emergencies. We may also give out PHI without your authorization to organ procurement organizations, coroners, medical examiners or funeral directors when an individual dies, health oversight agencies for activities authorized by law, for workers’ compensation claims and for special government functions such as military, national security, and presidential protective services. We provide PHI when otherwise required by law, such as for law enforcement in specific circumstances, or for judicial or administrative proceedings. Other examples include reporting disclosures about victims of abuse, neglect or domestic violence to proper authorities as well as to avert a serious threat to health or safety. In any other situation, we will ask for your written authorization before using or disclosing your PHI. If you choose to sign an authorization to allow disclosure of your PHI, you can later revoke that authorization, in writing, at any time, to stop any future uses and disclosures (other than for treatment, payment and health care operations).

We never market or sell personal information. We are prohibited from using or disclosing genetic information for underwriting purposes. We may change our policies at any time. Before we make a significant change in our policies, we will change our notice and send the new notice to you. The new notice will be available on our web sites, and we will mail a copy to you upon request.

Individual Rights

In most cases, you have the right to view or get a copy of your PHI. You also have the right to receive a list of instances where we have disclosed your PHI without your written authorization for reasons other than treatment, payment or health care operations. If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend any of the following information: (1) information that is not part of the medical information kept by or for the Plans; (2) Information that was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (3) information that is not part of the information which you would be permitted to inspect and copy; and (4) information that is accurate and complete.

You may request in writing that we not use or disclose your PHI for treatment, payment and health care operations except when specifically authorized by you, when required by law, or in emergency circumstances. We will consider your request but are not legally required to accept it. You also have the right to receive confidential communications of PHI by alternative means or at alternative locations, if you clearly state that disclosure of all or part of your PHI could endanger you.

Complaints

If you are concerned that we have violated your privacy rights, or you disagree with a decision we have made about access to your records, you may contact the address listed on the last page. You may also send a written complaint to the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/guidance/document/how-file-health-information-privacy-or-security-complaint. We will not retaliate against you for filing a complaint.

Our Legal Duty

We are required by law to protect the privacy of your information, provide this notice about our information practices, and follow the information practices that are described in this notice.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We will not use or share your information other than as described herein unless you provide us with a written authorization telling us we can disclose your information. You may revoke your authorization at any time, but you cannot revoke your authorization if we have already acted on it.

Upon request, we will provide a copy of your dental records, usually within 30 days. If you wish to inspect your records, receive a listing of disclosures, or correct or add to the information in your record, or if you have any questions, complaints or concerns, please call Customer Service at 1-800-448-3815 or contact us at the address below:

Delta Dental, Attn: Privacy Officer,
500 Washington Avenue South,
Suite 2060,
Minneapolis, MN 55415.

Effective: July 10, 2019, Updated 7/23/2021.