Notice of Privacy Practices

Effective as of January 1, 2015

THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

This Notice is being directed to all employers and individuals who receive the wellness services of AlivOn (formerly known as Forward Health & Wellness, LLC).

PRIVACY RESPONSIBILITY.

This Notice describes how we may collect, use and disclose your protected health information and your rights concerning your protected health information. "Protected health information" is information about you, including demographic information collected from you, that can reasonably be used to identify you and that relates to your past, present, or future physical condition, the provision of health care to you or the payment for that care.

Protected health information in this Notice includes information about you that appears on enrollment materials, health risk assessments (HRA's), biometric data, individualized coaching programs, and other records received and/or generated in writing, in person, by telephone, or electronically (such as your name, address, telephone number, and other demographic data.)

OUR PRIVACY RESPONSIBILITIES INCLUDE:

  • Protecting the privacy of any protected health information created or received about you and notifying you if there is a breach of your unsecured protected health information.
  • Providing you with this Notice that indicates AlivOn's privacy policies and our legal obligations regarding those policies.
  • Using and sharing protected health information as outlined in this Notice.
  • Notifying you when information within this Notice changes.

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION.

Uses and Disclosures for Payment, Health Care Operations and Treatment. We use and disclose protected health information in a number of different ways in connection with the payment of your health care, our health care operations, and your treatment. The following are only a few examples of the types of uses and disclosures of your protected health information that we are permitted to make without your authorization.

Payment: We will use and disclose your protected health information for purposes of payment. These uses and disclosures include: to administer your or your employer's wellness contract, which may involve the determination of eligibility; claims payment; utilization review and management; coordination of care, benefits and other services; and responding to complaints, appeals and external review requests. If you are receiving services through your employer's wellness program, we may need to share limited information with your employer for purposes of payment to us, such as the fact that you are one of the participants in the program. If you are receiving services as an individual, we may use your protected health information to determine your payment for our services.

Health Care Operations: Protected health information may be used or disclosed in order to perform necessary business activities in relation to your benefits and services received. These activities include: quality improvement surveys and studies; performance measurement and outcomes assessments; operation of preventive health, early detection and disease and case management and coordination of care programs, including information about treatment alternatives, therapies, health care providers, settings of care or other health-related services; risk management and audit services; data and information systems management; customer service; administrative management; and general administration of your benefits, such as determining whether you qualify for an incentive under your employer's wellness program. In this case, we may indicate to your employer whether you qualify for specific incentives; however, we will not share your specific health information as part of this disclosure. We may also share aggregate, de-identified data with your employer to evaluate the health needs of its employees as a whole.

Treatment: Protected health information may be used or disclosed in order to make sure that you are receiving the medical treatment and services needed as well as to suggest health-related services that may be of benefit to you. We may disclose your protected health information to health care providers (doctors, dentists, chiropractors, pharmacies, hospitals, and other caregivers) who request it in connection with your medical treatment. We may also use and/or disclose your protected health information to health care providers in connection with preventive health, early detection and disease and case management programs. Your specific protected health information will be used and disclosed by AlivOn and its affiliates to provide individualized assessments, health coaching, and health-related recommendations to you, as well as for related business functions.

In connection with foregoing activities, we may collect the following types of information about you:

  • Information we receive directly or indirectly from you or your employer, benefits plan sponsor or one of its business associates through applications, surveys, or other forms (e.g., name, address, social security number, date of birth, marital status, dependent information, employment information and medical history).
  • Information about your relationships and transactions with us and others (e.g., medical history, eligibility information, payment information ).

Affiliates and Business Associates. We may share your protected health information with affiliates and third party business associates that perform various activities for us or on our behalf. Whenever such arrangement involves the use or disclosure of your protected health information, we will have a written contract that contains terms designed to protect the privacy of your protected health information in accordance with applicable Federal and State law. We may also contact you about treatment alternatives or other health-related benefits and services that may be of interest to you.

Plan Administrative Functions. We may disclose protected health information to the plan sponsor to permit the plan sponsor to perform administrative functions. Please see your plan sponsor for a full explanation of the limited uses and disclosures that the plan sponsor may make of your protected health information in providing plan administrative functions for your group health plan, if applicable.

Use and Disclosure After the Completion of Services. We do not immediately destroy protected health information when employers and/or individuals terminate their relationship with us. The information is necessary and used for many of the purposes described above and is in many cases subject to legal retention requirements. However, the policies and procedures that protect this information against inappropriate use and disclosure apply regardless of whether you are currently receiving services from us, subject to applicable law.

Applicability of More Stringent State Law. Some of the uses and disclosures described in this notice may be limited in certain cases by applicable State laws that are more stringent than Federal laws, including disclosures related to substance abuse, developmental disability, alcohol and other drug abuse (AODA), and HIV testing.

Other Permitted or Required Uses and Disclosures of Protected Health Information.

We may use or disclose your protected health information in the following additional situations without your authorization:

Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, or any other person that you identify, the protected health information directly relevant to that person's involvement in your health care, particularly in the event of an emergency. If you are present for such a disclosure, we will either seek your verbal agreement to the disclosure or provide you an opportunity to object to it. We may also make such disclosures to the persons described above in situations where you are not present or you are unable to agree or object to the disclosure, if we determine that the disclosure is in your best interest. We may also disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Unless we are given an alternative address, we will mail information containing protected health information to you at the address that we have on record for you.

Informing You: Your protected health information may be used to let you know about health and wellness services that are offered by AlivOn, its affiliates, and/or the community in general. This may include contacting you for appointment reminders, follow-up care surveys, informing you of treatment alternatives or providing you with information about health-related benefits and services, subject to the other limitations in this Notice.

As Required by Law: Your protected health information may be used or disclosed to the extent that we are required to do so by law.

Legal Proceedings: We may disclose your protected health information in the course of any legal proceeding, in response to an order of a court or administrative tribunal and, in certain cases, in response to a subpoena, discovery request or other lawful processes.

Law Enforcement: We may disclose your protected health information under limited circumstances to law enforcement officials. For example, disclosures may be made in response to a warrant or subpoena or for the purpose of identifying or locating a suspect, witness or missing persons, or to provide information concerning victims of crimes.

Public Health: Your protected health information may be reported to a public health agency to help prevent or control disease, injury, disability, infection exposure, child abuse, or family violence. In addition, disclosures may be made as required to the Food and Drug Administration to report adverse events or product defects, track products, enable product recalls, make repairs or replacements, or conduct product surveillance.

Abuse or Neglect: We may make disclosures to government authorities concerning actual, alleged, or suspected abuse, neglect or domestic violence, in accordance with applicable law.

Health Oversight Activities: Your protected health information may be used by or disclosed to a governmental agency authorized to oversee the health care system or government programs or its contractors. Examples include: licensing and inspecting of medical facilities and audits or other proceedings related to the oversight of the health care system.

Coroners, Medical Examiners, or Funeral Directors: Protected health information may be used or disclosed to a medical examiner, coroner, or funeral director as needed to carry out duties authorized by law. For example, medical information may be necessary to identify a deceased person.

For Organ Donations: If you are an organ donor, information may be given to the organization that locates organs for the purpose of an organ transplantation or donation.

Worker's Compensation: Your protected health information may be used or disclosed to the extent required by worker's compensation laws.

Public Safety: Your protected health information may be used or disclosed in order to prevent or lessen a serious threat to your health or safety, to another person, or the general public.

Military Activity and National Security: If you are a veteran, your protected health information may be used or disclosed as required by veteran administration authorities. It also may be disclosed to Armed Forces personnel under certain circumstances and to authorized federal officials for the conduct of national security and intelligence activities.

Court of Other Hearings / Correctional Institutions: Your protected health information may be disclosed in order to comply with court orders and other hearings. If you are an inmate in a correctional facility, your information may be disclosed for the provision of health care to you or the health and safety of you or others.

De-Identified Information. We may use or disclose information without your consent to the extent it has been redacted so as not to identify you individually. This includes the sharing of de-identified, aggregate information with affiliates and third parties.

Uses and Disclosures of Protected Health Information with Your Authorization.

Your authorization is usually necessary to allow us to use or disclose your protected health information for certain marketing activities, including Treatment or Health Care Operations communications where we receive financial remuneration from a third party to communicate this information to you. We also do not sell your protected health information, nor will do we use or disclose your information for fundraising or other similar activities, except as permitted by law. We will also require an authorization from you in order to share your identifiable protected health information (PHI) with any third party requested by your employer (if applicable), such as a new wellness vendor. Other uses and disclosures of protected health information will be made only with your written authorization, unless otherwise permitted or required by law.

You may revoke your authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization. Please refer to the Contact Information for the telephone number and address for this request.

YOUR PROTECTED HEALTH INFORMATION PRIVACY RIGHTS.

The following are additional rights you have in relation to your protected health information:

Right to Review or Copy Your Protected Health Information: You have the right to review or copy records used to make decisions about your services. This right to review and/or copy does not include information needed for civil, criminal, administrative actions and proceedings, or psychotherapy notes, to the extent AlivOn has this information. We may ask that your request be in writing and to provide us with the specific information we need to fulfill your request. A fee will be charged to cover certain actual costs in relation to your request, and you may request your information in electronic format. Please refer to the Contact Information for the telephone number and address for this request.

Right to Correct Information You Believe to be Incorrect or Incomplete: You have the right to ask us to amend our records. All requests for amendments must be in writing. In certain cases, we may deny your request, as we may not have created the original information. All denials will be made in writing and will indicate how you can respond if you disagree. Please refer to the Contact Information for the telephone number and address for this request.

Right to Request a List of Who Was Given Your Information and Why: You have the right to have us provide you with a list of times when we have disclosed your protected health information for any purpose other than treatment, payment, or health care operations, national security purposes, or for any listing already provided to you. All requests must be in writing. We will require you to provide us with the specific information we need to fulfill your request, with specific dates required. This requirement applies for six years from the date of the disclosure. If you request a list more than once in a 12-month period, we may charge you certain actual costs in relation to your request. Please refer to the Contact Information for the telephone number and address for this request.

Right to Request Restrictions: You have the right to request restrictions on the way we use or disclose your protected health information for treatment, payment, or health care operations; however, we are not required to agree to these restrictions, unless that restriction is regarding disclosure of health information to your health plan and: (1) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (2) the health information pertains solely to a health care item or service for which you or another person (other than your health plan) paid for in full. If we agree to the restriction, we will comply with your request unless the information is needed to provide emergency treatment to you. All restriction requests must be made in writing. Please refer to the Contact Information for the telephone number and address for this request.

Right to Confidential Communications: You have the right to reasonable requests to communicate with you about your protected health information by alternative means or to alternative locations. Your request will be evaluated and you will be notified if it can be done. All requests must be made in writing. Please refer to the Contact Information for the telephone number and address for this request.

Right to Contact Information: You may exercise any of the rights described above by contacting AlivOn. All requests must be made in writing. Please refer to the Contact Information for the telephone number and address for this request.

CHANGES TO PRIVACY PRACTICES.

This notice may be changed or amended at any time. The changes are effective for all protected health information that we maintain. AlivOn will make available a new Notice of Privacy Practices whenever policy changes are made. You may request a paper copy of the Notice.

ADDITIONAL INFORMATION.

If you have any questions about this notice or would like an additional copy of this notice, please refer to the Contact Information for the telephone number and address for this request.

COMPLAINTS.

If you are concerned about this Notice of Privacy Practices or if you believe that your privacy rights may have been violated, please forward your written complaint to the address listed within the Contact Information.

CONTACT INFORMATION

For all above indicated requests or to report any concerns, please contact AlivOn at (715) 838-9355 or (800) 541-0093. Or you may write to the following:

  • AlivOn
  • Attn: Compliance Officer
  • 2503 N. Hillcrest Pkwy
  • Altoona, WI 54720