Member Privacy Policy

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.

Purpose The purpose of this notice is to:

  • Provide you with notice of Senior Care Plus’s information protection practices, and
  • Explain your rights as a Senior Care Plus member.

Senior Care Plus’s Responsibilities Senior Care Plus is required to abide by the terms of this notice currently in effect by:

  • Maintaining the privacy of your Protected Health Information, and
  • Providing you with notice of our legal duties and privacy practices with respect to Protected Health Information.

Notice Revisions Senior Care Plus reserves the right to revise the terms of this notice, and to make the revised terms effective for all Protected Health Information that it maintains. If Senior Care Plus revises this notice, we will make the revised notice available within sixty (60) days. Definitions Business Associate – A person or entity that uses Protected Health Information to perform a service for Senior Care Plus. These services include, but are not limited to: billing, claim processing, data entry Health Care Operations – Activities related to Senior Care Plus’s operations, including but not limited to: quality assessment and improvement, doctor performance evaluations, fraud and abuse detection, claim payment, claim audits, customer issue resolution. Payment – Senior Care Plus’s collection of insurance premiums or its determination and payment of claims. Protected Health Information – Information relating to a Senior Care Plus patient’s past, present or future health or condition, the provision of health care to a Senior Care Plus patient, or payment for the provision of health care to a Senior Care Plus patient. Protected Health Information includes, but is not limited to: patient name, Social Security number/member ID, service date diagnosis information, claim information Treatment – The provision, coordination or management of vision care and related services by one or more vision care providers. How Senior Care Plus Uses and Discloses Information About You Senior Care Plus will only use and disclose your Protected Health Information without your authorization when necessary for:

  • coordination of your vision care treatment
  • disclosure to your plan sponsor to the extent permitted by law
  • payment
  • health care operations, or
  • as required or permitted by law (please see “Use or Disclosure Required or Permitted by Law” section).

Disclosure to Senior Care Plus’s Business Associates Senior Care Plus will only disclose your Protected Health Information to Business Associates who have agreed in writing to maintain the privacy of Protected Health Information as required by law. Use or Disclosure Requiring Authorization Senior Care Plus will not use or disclose your Protected Health Information for purposes other than those described in this notice. If it becomes necessary to disclose any of your Protected Health Information for other reasons, Senior Care Plus will request your written authorization. Revoking Authorization: If you provide written authorization, you may revoke it at any time in writing, except to the extent that Senior Care Plus has relied upon the authorization prior to its being revoked. Use or Disclosure Required or Permitted by Law Senior Care Plus may use or disclose your Protected Health Information to the extent that the law requires the use or disclosure:

  • Public Health: For public health activities or as required by the public health authority.
  • Health Oversight: To a health oversight agency for activities such as audits, investigations and inspections. Oversight agencies include, but are not limited to, government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
  • Legal Proceedings: In response to an order of a court or administrative tribunal, in response to a subpoena, discovery request or other lawful process.
  • Law Enforcement: For law enforcement purposes, including: legal process or as otherwise required by law; limited information requests for identification and location; use or disclosure related to a victim of a crime; suspicion that death has occurred as a result of criminal conduct; if a crime occurs on Senior Care Plus’s premises; or in a medical emergency where it is likely that a crime has occurred.
  • Criminal Activity: As requested by law enforcement authorities, if 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.

Use and Disclosure Examples

  • Payment: Senior Care Plus uses Protected Health Information for payment processing to verify that services provided were covered under the patient’s vision care plan.
  • Health Care Operations: Senior Care Plus uses and discloses Protected Health Information to audit and review claims payment activity to ensure that claims were paid correctly.
  • Treatment: To coordinate treatment by a health care provider.

Review Your Protected Health Information You have a right to inspect and obtain a copy of your Protected Health Information. Important: If you feel your Protected Health Information is incorrect, you have the right to request that it be amended. Request to Restrict Your Protected Health Information You can request restrictions on the use and disclosure of your Protected Health Information. Senior Care Plus is not required to agree to a requested restriction. Example: If a restriction request prevents us from providing service to you or from performing payment related functions, we will not be able to agree to the request. Confidential Communication When necessary, Senior Care Plus mails your Protected Health Information to your home. If you feel receiving a copy of your Protected Health Information at your home could compromise your safety, you may request in writing, an alternate communication method and/or location. Important: Senior Care Plus will not ask for an explanation for such requests, but may request payment for this service. Examples: The patient may decide, for his or her safety, to have correspondence containing his or her Protected Health Information sent somewhere other than to his or her home, or to have the information sent via fax rather than mailed. Accounting of Disclosures If a disclosure of your Protected Health Information was made for a reason other than treatment, payment or health care operations, you have a right to receive an accounting of the disclosure. Important: If the disclosure was made to you, Senior Care Plus will not provide an accounting. Receive a Copy You can view and print a copy of this Notice of Privacy Practices from our website. You may also request a copy from Customer Service. Complaints If you believe that your privacy rights have been violated, you may submit a complaint to Senior Care Plus or to the U.S. Secretary of Health and Human Services at any time. Senior Care Plus will not retaliate against you for filing a complaint. File complaints with Senior Care Plus from our Appeals & Grievances page, or by calling our Customer Services Department at 888-775-7003, for complaints regarding:

  • Restrictions on the use or disclosure of your Protected Health Information
  • Amendments to your Protected Health Information, or
  • Accounting of the use or disclosure of your Protected Health Information.

File complaints with the U.S. Secretary of Health and Human Services using the HIPAA Complaint Submission Form, or by mail to: HIPAA Complaint, 7500 Security Blvd., C5-24-04, Baltimore, MD 21244, for complaints regarding: Senior Care Plus’s business practices, or the use of your Protected Health Information. Contact Senior Care Plus Contact us through the Senior Care Plus website or call our Customer Service Department at 888-775-7003 to request: restrictions on the use or disclosure of your Protected Health Information, amendments to your Protected Health Information, revoking authorizations, accounting of the use or disclosure of your Protected Health Information, or a copy of your Protected Health Information.

Senior Care Plus
A Medicare Advantage organization from Hometown Health