Notice of Privacy Practices
This notice describes (1) How medical information about you may be used and disclosed; and (2) How you can get access to this information.
Please Review Carefully. Effective October 1, 2003

Care1st Health Plan Arizona, Inc. appreciates your confidence and trust in allowing us to manage your health care needs. We respect your privacy and will protect the medical information we receive about you.

This notice will tell you about how we may use and disclose medical information we receive about you. This notice also explains some of your rights and some of our duties regarding the use and disclosure of you medical information.

How We May Use and Disclose Medical Information About You:
For Treatment
We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, or other hospital personnel involved in taking care of you. We also may disclose medical information about you to people outside of the health plan who may be involved in your medical care, such as family members or others who provide services that are part of your care.

For Payment
We may use and disclose medical information about you so that providers you receive treatment and services from may receive payment. Examples of payment activities include, billing, claims management and other related administrative functions.

For Health Care Operations
We may use and disclose medical information about you for our health care operations. These uses and disclosures are necessary to run the health plan and to make sure that people covered by our plan receive quality care. For example, we may use medical information to review the treatment and services rendered by a provider to evaluate the provider’s performance.

When Required by Law
We will disclose medical information about you when required to do so by federal or state law.

To Prevent a Serious Threat to Health or Safety
We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would be limited to disclosure to someone able to help prevent the threat.

Health Oversight Activities
We may disclose medical information to AHCCCS or another health oversight agency for activities authorized by law.

Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.

Law Enforcement
We may release medical information if asked to do so by a law enforcement official:

Other Uses
We will obtain your written permission prior to use or disclosure of your medical information if the law does not permit use or disclosure without your permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. Understand that we are unable to protect information that has already been disclosed with your permission.

Your Rights Regarding Your Medical Information:
You have the following rights regarding medical information we maintain about you:

Right to Request Restrictions
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.

We are not required to agree to your request. If we do agree we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to the Care 1st Compliance Office at 2355 E. Camelback Rd., Ste. 300, Phoenix, Arizona 85016. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.

Communications
You have the right to request that we communicate with you only in writing or at a certain address. We will accept reasonable requests. Your request must specify how or where you wish to be contacted and what information is to be communicated in this manner.

Inspect and Copy
You or your personal representative has the right to get a copy of your health information. The information provided will be information available to you under the law. Limitations may apply to certain types of information. You must request this information in writing and we may bill you for reasonable costs of complying with this request. The request should be addressed to the Care 1st Compliance Office and sent to the address provided below.

We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. The person conducting the review will not be the person who denied your request.

Amendments
You have the right to ask that information in your records, created by the health plan, be amended if it is not correct or complete. Your request must be in writing and submitted to the Care 1st Compliance Office. We may deny your request for the following reasons (not all inclusive)

Accounting of Disclosures
You have the right to a request a list of

The list will not include instances when we shared information with you, with your permission, or for treatment, payment or health care operations. Upon request, one free copy is available every 12 months.

You Have a Right to a Paper Copy of this Notice
You may obtain a copy of this notice by contacting our Member Services Department at 1-866-560-4042 or 602-778-1800.

Changes to This Notice
We reserve the right to change this notice.

Complaints
You have the right to file a complaint if you believe your privacy rights have been violated. You will not be penalized for filing a complaint. To file a complaint you may write to us at:

Care 1st Health Plan Arizona
Atten: Member Services
2355 E. Camelback, Ste. 300
Phoenix, AZ 85016

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services Office of Civil Rights.

For further information please contact our Member Services Department at 602-778-1800 or 1-866-560-4042.