Group US, Inc. / Carolina Consulting Services, Inc.
This notice is in effect as of April 14, 2003
In Compliance with Title V of the GRAMM-LEACH-BLILEY
ACT (GLBA) and associated state laws and in accordance with our
contractual obligations to various COVERED ENTITIES as BUSINESS
ASSOCIATES under Federal Laws pertaining to privacy of
personally-identifiable health information and protected health
information under regulations relating to the Health Insurance
Portability and Accountability Act of 1996 (HIPAA), we are providing you
with this document, which notifies you of the privacy policies and
practices of Carolina Consulting
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.
required by law to maintain the privacy of your personally
identifiable health and nonpublic personal information and to provide
you with this notice of our privacy practices and legal duties. We are
required to abide by the terms of this notice. We reserve the right to
change the terms of this notice and to adopt any new provisions
regarding the personal health information that we maintain about you.
If we revise this notice, we will provide you with a revised notice by
mail or hand delivery.
Statement of Our Duties.
Statement of Your Rights. You have a right to know
how we may use or disclose your personal health information. This
notice informs you of those uses and disclosures. There are certain
uses and disclosures of your personal health information that we are
permitted or required to make under law without your permission. For
all other uses and disclosures, we first must obtain your permission.
In addition, you have the following rights:
The right to request that we place additional restrictions on our
uses and disclosures of your personal health information. However, we
are not obligated to agree to impose any such additional restrictions.
The right to access, inspect and copy the protected information
pertaining to you that we maintain in our files about you, and the
right to have us correct or amend any information that we create in
error. Requests to access or amend your health information should be
sent to the contact person and address provided in Paragraph 8 below.
The right to receive an accounting of the disclosures of your
personal health information that we make for purposes other than
activities related to your treatment, or our payment functions or
other health care operations.
The right to request that you receive communications of personal
health information in a confidential manner.
If you received this notice electronically, you also have the
right to obtain a paper copy of this notice from us on request.
Information We Collect About You. We collect the
following categories of information
and/or individual policies
from the following sources:
- Information that we obtain directly from you, in conversations
or on applications or other forms that you fill out.
- Information regarding current or prospective plan participants
we obtain about them on applications or other forms.
- Information about the plan’s transactions with our affiliates,
others or us.
- Information that we obtain as a result of our transactions with
Permissible Uses and Disclosures of Protected
Information. We disclose the information we receive regarding
current or prospective plan participants only in accordance with the
terms and conditions of the various Business Associate contracts we
have entered to with Covered Entities under HIPAA Privacy Regulations
and as permitted under state and federal laws concerning the privacy
of your insurance and financial information. Those include:
Permissible Uses and Disclosures
Situations Permitted or Required by Law. We also may use or
disclose your protected health information without your written
permission for other purposes permitted or required by law, including
For any Purposes to Which you have Not Objected. In certain
limited circumstances, we may use or disclose your protected health
information after we have given you an opportunity to object and you
have not objected. For example, if you do not object, we may use
limited information about you to maintain an office directory, to
notify family members or any other person identified by you regarding
issues directly related to such person’s involvement with your care or
payment for that care, or in emergency circumstances.
For Purposes for Which We Have Obtained your Written Permission.
All other uses or disclosures of your protected health information
will be made only with your written permission, and you may revoke any
permission that you give us at any time.
- As authorized by and to the extent necessary to comply with
workers’ compensation or other no-fault laws;
- To an oversight or insurance regulatory agency for activities
including audits or civil, criminal or administrative actions;
- To a public health authority for purposes of public health
activities (such as to the Federal Food and Drug Administration to
report consumer product defects);
- To a law enforcement official for law enforcement purposes or
in response to a court order or in the course of any judicial or
- To organ procurement organizations or other entities for
approved research; or
- To a governmental authority, including a social service or
protective services agency, authorized to receive reports of
abuse, neglect or domestic violence.
Complaints About Misuse of Health Information. You
may complain either directly to us or to the Secretary of Health and
Human Services if you believe that your rights with respect to our
protection of your health information have been violated. To file a
complaint with us, you may send a written statement outlining your
complaint, the facts and circumstances surrounding your complaint,
including the names, dates and as many details as possible. You will
not be retaliated against in any way for filing a complaint.
We restrict access to nonpublic personal and
personally-identifiable health information about you to those
employees and agents who need to know that information in order to
provide products and services to you. We maintain physical, electronic
and procedural safeguards that comply with state & federal regulations
to guard your nonpublic personal information.
Our Practices Regarding Confidentiality and Security.
or the breach thereof, shall be settled by arbitration in accordance
with the rules of the American Arbitration Association, and judgment
upon the award rendered by the arbitrator(s) may be entered in any
court having jurisdiction thereof.
Our Policy Regarding Dispute Resolution.
Our contact/Privacy Officer is:
Contact Person for Filing Complaint or Obtaining Other
William J. Brannon
Carolina Consulting Services, Inc.
2-B Terrace Way
Greensboro, NC 27403
(336) 294-4440 Fax (336) 547-9400
© 2003 The Benefits & Insurance Law Center
David Curtis Smith, Attorney PLLC)