Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you get access to this information. Please review it carefully.

Legal Obligations

We are required by applicable federal and state law to maintain the privacy of your medical information, to give you this notice of our legal duties and privacy practices and about your rights concerning your medical information and to follow the terms of the notice currently in effect.

MAPFRE LIFE INSURANCE COMPANY strongly believes in protecting the confidentiality and security of the information we collect about you.  We are committed to protect your medical and personal information.  This individually identifiable information, whether oral or recorded about your past, present or future health or mental condition or payment history for your health care services, is considered Protected Health Information (PHI). In conducting our business, we protect your Personal Health Information from inappropriate use or disclosure.  This Notice of Privacy Practices describes how we may use and disclose your PHI to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.

This notice will become effective on April 14, 2003.   We are required to abide by the terms of this Notice of Privacy Practices.  We reserve the right to make changes to the terms of our notice at any time.  The new notice will be effective for all protected health information that we maintain at that time and for any of your PHI we may create or maintain in the future.  When we make a significant change in our privacy practices, we will change this Notice and send the new Notice to you at the time of the change.

Uses and Disclosures Personal and Health Information

In order to provide you with insurance coverage, we need personal information about you, and we obtain this information from many different sources, particularly your employer or benefits plan sponsor, other insurers, HMOs or third-party administrators (TPA), and health care providers. 

Required:  We must disclose your PHI to you or someone who has the legal right to act for you (your personal representative).  We must also disclose your PHI to the Secretary of the Department of Health and Human Services, if necessary, when he is undertaking a compliance investigation or review or enforcement action.

Permissive: In administering your health benefits and providing pharmacy services, we may use and disclose PHI about you in various ways, including:

For Health Care Operations:  We may use and disclose your PHI during the course of running our health business, that is, during operational activities, including but not limited to, quality assessment and improvement; licensing; accreditation by independent organizations, performance measurement and outcomes assessment; health services research; and preventive health care, disease management, audits, case management and care coordination.  For example, we may use the information to provide disease management programs for members with specific conditions, such as diabetes, asthma or heart failure. Other operational activities requiring use and disclosure include administration of reinsurance and stop loss; underwriting and rating; legal services including detection and investigation of fraud and abuse; administration of pharmaceutical programs and payments; and other general administrative activities, including data and information systems management, and customer service.

Payment:  We may use and disclose your PHI to pay for your covered services in conducting utilization and medical necessity reviews; coordinating care; to coordinate benefits with others payers; to issue explanations of benefits; determining eligibility; determining forms compliance; collecting premiums; calculating cost-sharing amounts.  For example, we may use your PHI to decide whether a particular treatment is medically necessary and what the payment should be, and during the process, we may disclose PHI to your provider.  We also mail Explanation of Benefits forms and other information to the address we have on your record (i.e. primary insured).  We also use your PHI to obtain payment for any mail order pharmacy services provided to you.

Treatment: We may disclose PHI to doctors, dentists, pharmacies, hospitals and other health care providers who take care of you.  For example, doctors may request PHI from us to supplement their own records.  We may also use PHI in providing mail order pharmacy services and by sending certain information to doctors for patient safety or other treatment-related reasons.

Disclosures to Other Covered Entities:  We may disclose PHI to other covered entities, or business associates of those entities for treatment, payment and certain health care operations purposes.  For example, we may disclose personal information to other health plans maintained by your employer if it has been arranged for us to do so in order to have certain expenses reimbursed.

Additional Reasons for Disclosure

We may use or disclose PHI about you in support of: 

• Communications - in providing you with treatment alternatives, treatment reminders, or other health-related benefits and services.
• Research - to researchers, provided measures are taken to protect your privacy.
• Business Associates - to persons who provide services to us and assure us they will protect the information.
• Plan Sponsors - to your sponsor or employer, to verify enrollment, when we have been informed that appropriate language has been included in your plan documents, or when summary data is disclosed to assist in bidding or amending a group health plan. Plan sponsors are employers or other organizations that sponsor a group health plan.
• Regulation - to state insurance departments, boards of pharmacy, U.S Food and Drug Administration, U.S. Department of Labor and other government agencies that regulate us.
• Law Enforcement - to federal, state and local law enforcement officials, for law enforcement purpose or  prevent or lessen a serious and imminent threat to the health or safety of a person or the public, as long as applicable requirements are met.
• Legal Proceedings - in response to a court or administrative order, subpoena, warrant, summons, discovery request, or an administrative or judicial proceeding.
• Others Involved in Your Healthcare - unless you object, to a member of your family, a relative, a close friend or any other person you identify as been involved in your heath care or payment for that care. We disclose only PHI that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure we may disclose such information as necessary if we determine that it is in your best interest.  You can contact our Privacy Officer at 787-250-5122 or have the provider contact us.
• Funeral Directors, Coroners, Medical Examiners - for identifications purposes, determining cause of death or to perform other duties authorized by law.
• Public Health or Welfare - to address matters of public health interest as required or permitted by law (e.g., child or adult abuse and neglect, domestic violence, threats to public health and safety, disaster relief or emergency situation and national security).

Uses and Disclosures Requiring your Written Authorization

In all situations other than those described above, we will ask for your written authorization before using or disclosing personal information about you.  If you have given us an authorization, you may revoke it at any time, if we have not already acted on it.  If you have questions regarding authorizations, please call our Privacy Officer at
787-250-5122.

Please note that we do not destroy personal information about you when you terminate your coverage with us.  It may be necessary to use and disclose this information for the purposes described above even after your coverage terminates, although policies and procedures will remain in place to protect against inappropriate use or disclosure.

Your Rights

The federal privacy regulations give you the right to make certain requests regarding health information about you.  You have the right to:

• Obtain a copy of health information that is contained in a "designated record set", (medical records and other records maintained and used in making enrollment, payment, claims adjudication, medical management and other decisions), as long as we maintain the PHI .  We may ask you to make your request in writing, may charge a reasonable fee for producing and mailing the copies and, in certain cases we may deny the request. Under federal law there are some records not subject to inspection or copy.  A decision to deny access may be reviewed.  Please contact our Privacy Officer if you have questions about access to your designated record set.
• Amend health information that is in a "designated record set", as long as we maintain the PHI, when it is incorrect or incomplete.  Your request must be in writing and must include the reason for the request.  If we deny the request, you have the right to file a written statement of disagreement.
• Obtain a list of those to whom we or business associates disclosed the PHI of your "designated record set" other than those made for medical treatment, health care operations, treatment payment, made to you or persons involved in your care, national security purposes, to correctional institution personnel and those you specifically authorized. Your request must be in writing. You can request an accounting for up to 6 years prior to the date of the request, but not prior to April 14, 2003. It must be a written request. If you request such an accounting more than once in a 12-month period, we may charge a reasonable fee.
• Request restrictions on the use or disclosing of your PHI.  This means you may ask us not to use or disclose any part of your PHI to certain persons that may be involved in your health care, including family members or friends. We are not required to agree to your request.  We will use our best efforts to comply with all approved requests except when the information is needed to provide emergency treatment or as required or authorized by law.
• Request to receive confidential communications from us by alternative means or at an alternative location.  We will not accept E-Mail addresses as an alternative means or location for communications.  It must be a written request and it be a reasonable alternate address or other method to deliver confidential communications.  We will accommodate reasonable requests.
• Obtain a paper copy of this notice from us, even if you have agreed to accept this notice electronically.
• You may ask for forms or specific instructions of how to make any of the requests described above, or may request a paper copy of this notice, by calling the Privacy Officer at 787-250-5122.

You also have the right to file a complaint with the Secretary of the Department of Health and Human Services if you think your privacy rights have been violated.

 You will not be penalized for filing a complaint.

If you have any questions regarding this notice or if you think your privacy rights have been violated, please contact MAPFRE LIFE's Privacy Officer by mail at:
 
MAPFRE LIFE INSURANCE COMPANY
Attn: Privacy Office
PO Box 70333
San Juan, Puerto Rico 00936-8333

or by phone at 787-250-5122 or by Fax at 787-250-5298.  Include your name, phone and fax.