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www.aptia365.com/horacemann 32 Copyright 2024 Aptia Insurance Services Group, LLC. All rights reserved.PHYSICIAN DESIGNATION NOTICEThe Quartz Medium Plan generally requires/allows the designation of a primary care provider. You have the right to designate any primary care provider who participates in our network and who is available to accept you or your family members. Until you make this designation Quartz designates one for you. For information on how to select a primary care provider, and for a list of the participating primary care providers, contact the plan administrator or issuer at Quartz customer service 800-362-3310.HORACE MANN HIPAA PRIVACY NOTICEPlease carefully review this notice. It describes how medical information about you may be used and disclosed and how you can get access to this information. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) imposes numerous requirements on the use and disclosure of individual health information by Horace Mann health plans. This information, known as protected health information, includes almost all individually identifiable health information held by a plan %u2014 whether received in writing, in an electronic medium or as an oral communication. This notice describes the privacy practices of these plans: Blue Cross Blue Shield of IL $2,000, $3,300 and $4,500 Deductible with HSA Plans. The plans covered by this notice may share health information with each other to carry out treatment, payment or healthcare operations. These plans are collectively referred to as the Plan in this notice, unless specified otherwise.THE PLAN%u2019S DUTIES WITH RESPECT TO HEALTH INFORMATION ABOUT YOUThe Plan is required by law to maintain the privacy of your health information and to provide you with this notice of the Plan%u2019s legal duties and privacy practices with respect to your health information. If you participate in an insured plan option, you will receive a notice directly from the Insurer. It%u2019s important to note that these rules apply to the Plan, not Horace Mann as an employer %u2014 that%u2019s the way the HIPAA rules work. Different policies may apply to other Horace Mann programs or to data unrelated to the Plan.HOW THE PLAN MAY USE OR DISCLOSE YOUR HEALTH INFORMATIONThe privacy rules generally allow the use and disclosure of your health information without your permission (known as an authorization) for purposes of healthcare treatment, payment activities and healthcare operations. Here are some examples of what that might entail:%u2022 Treatment includes providing, coordinating, or managing healthcare by one or more healthcare providers or doctors. Treatment can also include coordination or management of care between a provider and a third party, and consultation and referrals between providers. For example, the Plan may share your health information with physicians who are treating you.%u2022 Payment includes activities by this Plan, other plans, or providers to obtain premiums, make coverage determinations, and provide reimbursement for healthcare. This can include determining eligibility, reviewing services for medical necessity or appropriateness, engaging in utilization management activities, claims management, and billing; as well as performing %u201cbehind the scenes%u201d plan functions, such as risk adjustment, collection or reinsurance. For example, the Plan may share information about your coverage or the expenses you have incurred with another health plan to coordinate payment of benefits.%u2022 Healthcare operations include activities by this Plan (and, in limited circumstances, by other plans or providers), such as wellness and risk assessment programs, quality assessment and improvement activities, customer service and internal grievance resolution. Healthcare operations also include evaluating vendors; engaging in credentialing, training and accreditation activities; performing underwriting or premium rating; arranging for medical review and audit activities; and conducting business planning and development. For example, the Plan may use information about your claims to audit the third parties that approve payment for Plan benefits.The amount of health information used, disclosed or requested will be limited and, when needed, restricted to the minimum necessary to accomplish the intended purposes, as defined under the HIPAA rules. If the Plan uses or discloses Personal Health Information (PHI) for underwriting purposes, the Plan will not use or disclose PHI that is your genetic information for such purposes.HOW THE PLAN MAY SHARE YOUR HEALTH INFORMATION WITH HORACE MANNThe Plan, or its health insurer or Health Maintenance Organization (HMO), may disclose your health information without your written authorization to Horace Mann for plan administration purposes. Horace Mann may need your health information to administer benefits under the Plan. Horace Mann agrees not to use or disclose your health information other than as permitted or required by the Plan documents and by law. Benefits, Payroll, and/or HR staff are the only Horace Mann employees who will have access to your health information for plan administration functions.Here%u2019s how additional information may be shared between the Plan and Horace Mann, as allowed under the HIPAA rules:%u2022 The Plan, or its insurer or HMO, may disclose %u201csummary health information%u201d to Horace Mann, if requested, for purposes of obtaining premium bids to provide coverage under the Plan or for modifying, amending, or terminating the Plan. Summary health information is information that summarizes participants%u2019 claims information, from which names and other identifying information have been removed.%u2022 The Plan, or its insurer or HMO, may disclose to Horace Mann information on whether an individual is participating in the Plan or has enrolled or disenrolled in an insurance option or HMO offered by the Plan.%u2022 In addition, you should know that Horace Mann cannot and will not use health information obtained from the Plan for any employmentrelated actions. However, health information collected by Horace Mann from other sources %u2014 for example, under the Family and Medical Leave Act, Americans with Disabilities Act, or workers%u2019 compensation programs %u2014 is not protected under HIPAA (although this type of information may be protected under other federal or state laws).