Privacy Notice

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical information about you and your health is personal.  We are committed to protecting medical information about you.  We create a record of the health care claims reimbursed under the Plan for Plan administration purposes.  This notice applies to all of the medical records we maintain.  This notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

• make sure that medical information that identifies you is kept private;
• give you this notice of our legal duties and privacy practices with respect to medical information about you; and

• follow the terms of the notice that is currently in effect.

Your Protected Health Information (PHI) will be disclosed to certain employees of Cafeteria Plan Advisors, Inc.  These individuals may only use your PHI for Plan administration functions including those described below, provided they do not violate the provisions set forth herein.  Any employee who violates the rules for handling PHI established herein will be subject to adverse disciplinary action. 

Cafeteria Plan Advisors, Inc has certified that it will comply with the privacy procedures set forth herein and may not use or disclose your PHI other than as provided herein or as required by law.  Any agents or subcontractors who are provided your PHI must agree to be bound by the restrictions and conditions concerning your PHI found herein.  Your PHI may not be used by your Employer for any employment-related actions or decisions or in connection with any other benefit or employee benefit plan of your Employer. 

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.

The following categories describe different ways that we use and disclose medical information for purposes of health plan administration. Not every use or disclosure in a category will be listed.  However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Payment (as described in applicable regulations).  We may use and disclose medical information about you to determine eligibility for Plan benefits, to facilitate payment of claims for the treatment and services you receive from health care providers, to determine benefit responsibility under the Plan, or to coordinate Plan coverage. 

As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

You may obtain a copy of this notice at our website, www.cpa125.com. To obtain a paper copy of this notice, contact Cafeteria Plan Advisors, Inc.

When Cafeteria Plan Advisors, Inc no longer needs PHI disclosed to it by the Plan, for the purposes for which the PHI was disclosed, Cafeteria Plan Advisors, Inc. must, if feasible, return or destroy the PHI that is no longer needed.  If it is not feasible to return or destroy the PHI, Cafeteria Plan Advisors, Inc must limit further uses and disclosures of the PHI to those purposes that make the return or destruction of the PHI infeasible.

CHANGES TO THIS NOTICE

We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.