Page 38 - Willscot I Mobile Mini Open Enrollment Guide

RIGHT TO RECEIVE AN ACCOUNTING OF DISCLOSURES OF YOUR HEALTH INFORMATION
You have the right to a list of certain disclosures of your health information the Plan has made. This is often referred to as an “accounting of disclosures.” You generally may receive this accounting if the disclosure is required by law, in connection with public health activities, or in similar situations listed in the Other Allowable Uses or Disclosures of your Health Information section earlier in this notice, unless otherwise indicated below.
You may receive information on disclosures of your health information for up to six years before the date of your request. You do not have a right to receive an accounting of any disclosures made in any of these circumstances:
• Fortreatment,paymentorhealthcareoperations.
• Toyouaboutyourownhealthinformation.
• Incidentaltootherpermittedorrequireddisclosures.
• Whereauthorizationwasprovided.
• Tofamilymembersorfriendsinvolvedinyourcare(wheredisclosureispermittedwithoutauthorization).
• Fornationalsecurityorintelligencepurposesortocorrectionalinstitutionsorlawenforcementofficialsincertaincircumstances. • Aspartofa“limiteddataset”(healthinformationthatexcludescertainidentifyinginformation).
In addition, your right to an accounting of disclosures to a health oversight agency or law enforcement official may be suspended at the request of the agency or official.
If you want to exercise this right, your request to the Plan must be in writing. Within 60 days of the request, the Plan will provide you with the list of disclosures or a written statement that the time period for providing this list will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request. You may make one request in any 12-month period at no cost to you, but the Plan may charge a fee for subsequent requests. You’ll be notified of the fee in advance and have the opportunity to change or revoke your request.
RIGHT TO OBTAIN A PAPER COPY OF THIS NOTICE FROM THE PLAN UPON REQUEST
You have the right to obtain a paper copy of this privacy notice upon request. Even individuals who agreed to receive this notice electronically may request a paper copy at any time.
CHANGES TO THE INFORMATION IN THIS NOTICE
The Plan must abide by the terms of the privacy notice currently in effect. This notice takes effect on January 1, 2022. However, the Plan reserves the right to change the terms of its privacy policies, as described in this notice, at any time and to make new provisions effective for all health information that the Plan maintains. This includes health information that was previously created or received, not just health information created or received after the policy is changed. If changes are made to the Plan’s privacy policies described in this notice, you will be provided with a revised privacy notice.
COMPLAINTS
If you believe your privacy rights have been violated or your Plan has not followed its legal obligations under HIPAA, you may complain to the Plan and to the Secretary of Health and Human Services. You won’t be retaliated against for filing a complaint. To file a complaint, contact the Benefits Department at 1-480-894-6311 or benefits@mobilemini.com.
CONTACT
For more information on the Plan’s privacy policies or your rights under HIPAA, contact the Benefits Department at 1-480-894-6311 or benefits@mobilemini.com.
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