HIPAA Notice

HIPAA Notice of Privacy Practices

Last Updated: November 2024

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.

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. This notice applies to health insurance products and services where we collect and maintain protected health information (PHI).

How We May Use and Disclose Medical Information

For Treatment

We may disclose medical information about you to doctors, hospitals, and other health care providers who are involved in your care.

For Payment

We may use and disclose medical information about you to process claims, determine eligibility, coordinate benefits, and conduct utilization review activities.

For Health Care Operations

We may use and disclose medical information about you for our health care operations, including quality assessment, licensing, and business planning.

As Required by Law

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

To Avert a Serious Threat to Health or Safety

We may use and disclose medical information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Your Rights Regarding Medical Information

Right to Inspect and Copy

You have the right to inspect and copy medical information that may be used to make decisions about your care or payment for your care.

Right to Amend

If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.

Right to an Accounting of Disclosures

You have the right to request a list of the disclosures we made of medical information about you.

Right to Request Restrictions

You have the right to request a restriction on the medical information we use or disclose about you.

Right to Request Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice at any time.

Our Responsibilities

• We are required by law to maintain the privacy of protected health information
• We are required to provide you with this notice of our legal duties and privacy practices
• We are required to abide by the terms of this notice currently in effect
• We will notify you following a breach of unsecured protected health information

Changes to This Notice

We reserve the right to change this notice and the revised notice will be effective for all protected health information we already have about you as well as any information we receive in the future.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact:

Privacy Officer
Cauldron Insurance Agency
Email: privacy@cauldroninsurance.com
Phone: (555) 123-4567

You will not be penalized for filing a complaint.