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 describes how we protect the privacy of our members’ (and former members’) nonpublic personal information. It also explains your rights and how we obtain, use, and protect your nonpublic personal information. WellFirst Health — provided by SSM Health Plan — is required by law to maintain the privacy and security of your personal health and financial information (i.e., nonpublic personal information). We will notify you right away if a breach occurs that may have compromised the privacy or security of your nonpublic personal information. We understand the importance of keeping your nonpublic personal information safe. We are required to provide you with a written notice of our legal duties and privacy practices about that information.
We collect different types of nonpublic personal information to help us mange your health insurance coverage and benefits. We collect nonpublic personal information about you from some of the following sources.
We will not use or release your health information without your written permission, except as described in this Notice. In some cases, you may be able to ask us to disclose your health information to the third-party application of your choosing. For the most part, you have the right and choice to tell us to:
If you are not able to share your preference, such as if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In the following cases we never share your information unless you give us written permission:
If you do give us written authorization to use or release your health information for a particular purpose, you may change your mind at any time. You must let us know in writing if you change your mind.
We will not release your nonpublic personal information unless we are allowed or required by law to do so. The following describes the ways that WellFirst may use and release your nonpublic personal information. For each way we might use or release your information, we will explain what we mean and give some examples. Not every use or release we might make will be listed. However, all the ways we are allowed to use or release information will fall within one of these items.
Note: Some of the uses and releases described in this notice may be limited in certain cases by laws that are stricter than Federal Privacy laws, including releases related to mental health and substance abuse, developmental disability, alcohol and other drug abuse (AODA), and HIV testing.
Notice: We are part of an organized health care arrangement (OHCA) with SSM Health Plan and Dean Health System. As part of the OHCA, we may from time to time share your information with other members of the OHCA in order to perform joint health care tasks. These uses and releases allow the OHCA to run efficiently. For example, we may share your information to: better population health management, perform quality checks and other improvement activities, arrange for medical review, legal services, audit services, and fraud and abuse detection programs; business planning and development such as cost management; and business management and general OHCA activities.
We are allowed to use and release information for one of the following reasons:
We limit the gathering of your nonpublic personal information to only what we need to run our business, provide quality service, and meet regulatory requirements. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to safeguard your nonpublic personal information. We limit the internal use of oral, written, and electronic use of this information about you and ensure that only staff and business associates with the need to know have access to it. We have safeguards for your nonpublic personal information and review them regularly to protect your privacy.
We may change this Notice from time to time and make the new Notice effective for all nonpublic personal information we maintain, including information we created or collected before the change. We will always follow the current version of this Notice. The new notice will be available upon request, and on our website.
Submit complaints about this Notice or how we handle your health information, in writing, to our Privacy Officer. We will not hold any complaint you submit against you in any way. In addition, if you believe your privacy rights have been violated, you may file a complaint with the Secretary of the U.S. Department of Health and Human Services.
If you have questions, complaints, or want to exercise any of your health information rights, call the Customer Care Center at 800-279-1301 (or, if you purchased coverage on the Marketplace, at 800-279-1302) or contact us at the following address:
PO Box 56099
Madison, WI 53705
The effective date of this notice is 5/21/21.