HIPAA

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION

PLEASE REVIEW THIS CAREFULLY

We are providing this Notice from the Central Pennsylvania Teamsters Health & Welfare Fund ( the “Fund”) in order to inform you about the way that your protected health information (“PHI”) may be used and/or disclosed by the Fund. PHI is information collected, maintained, used and/or disclosed by the Fund, including demographic information, that may identify you and that relates to health care services provided to you, the payment of health care services provided to you, or your physical or mental health or condition, in the past, present or future. The Fund also pledges to provide you with certain rights related to your PHI, including your substance use disorder information to the extent the Fund receives, maintains or transmits records that are subject to 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records (“Part 2”).

The Fund is required by federal law to maintain the privacy of your PHI. The Fund is required by federal law to provide you with this Notice of Privacy Practices (“Notice”), this Notice informs you of the legal obligations under the federal privacy laws contained in the Health Insurance Portability and Accountability Act of 1996 and the Health Information Technology for Economic and Clinical Health Act and the related regulations (collectively “HIPAA”).

The Notice also informs you how the Fund uses and discloses your PHI and explains the rights that you have with regard to your PHI maintained by the Fund.

The Fund must follow the terms of this Notice currently in effect. The Fund reserves the right to amend or modify these privacy policies and practices and make new practices effective for all PHI that it maintains, including your PHI that it created or received prior to the effective date of the change and your PHI it may receive in the future.

Changes in our policies and practices may be required by changes in federal and state laws and regulations. Regardless of the reason for the change, we will provide you with notice of any material changes within sixty (60) days (or within such other time frame required under the regulations) of the date the change is adopted. The Fund will post the material change or revised Notice on its website by the effective date of the material change.

This Notice was effective September 23, 2013, and was revised August 29, 2016 and revised again in February 16, 2026 to protect Confidentiality of Substance Use Disorder Patient Records. This Notice will remain in effect unless and until the Fund publishes a revised Notice.

What information is covered by this Notice? The Fund collects certain PHI about you to help provide health benefits to you, as well as to fulfill legal requirements. The Fund collects this information, which identifies you, from applications and other forms that you complete, through conversations you may have with the Fund Office administrative staff and health care providers, and from reports and data provided to the Fund by health care service providers. The PHI that the Fund has about you includes, among other things, your name, address, phone number, birth date, social security number, and medical and health claims information. This is the information that is covered by the privacy practices described in this Notice.

What information is not covered by this Notice? This Notice does not apply to non-health employee benefits, including disability benefits, life insurance, accidental death and dismemberment insurance, and workers’ compensation insurance. This Notice also does not apply to health information that is received and maintained for employment purposes or medical leave benefits under the Family and Medical Leave Act or disability accommodations under the Americans with Disabilities Act.

Under HIPAA, how may the Fund use my PHI? The Fund may use your PHI to facilitate your treatment, to make or obtain payment for your treatment and for health plan operations, including administration, oversight, and other legal purposes.

How may the Fund use my PHI with respect to treatment and payment for my treatment? The Fund may use your PHI to assist the provider in treating you; for example, if the Fund maintains information about interactions between your prescription medications. Additionally, the Fund may use your PHI to make payments for the services you and your family receive. The Fund may use your PHI for making payment to providers for services or treatment you received, for making arrangements for payment through one of the networks of providers through which the Fund provides benefits to you, as well as for coordinating payment to providers though other health plans under the Fund’s coordination of benefits rule. For example, the Fund provides participants with access to a network of providers outside this immediate geographic area. The Fund may provide your PHI to the network and directly to the provider in order to ensure that the provider receives the appropriate payment for the services that have been provided to you.

How does HIPAA permit the Fund to use my PHI with respect to health care operations? The Fund may use your PHI to assess the quality of the Fund’s plan of benefits as well as for its administration and operations. These activities include, but are not limited to, ensuring that participants or their beneficiaries are eligible for benefits prior to making payment; taking corrective action to recoup overpayments and assessing health plan performance; reviewing the Fund’s plan of benefits and determining whether a reduction in costs is possible; continuing case management and coordination of care; commissioning and reviewing actuarial studies relating to the cost of benefits and management studies relating to the operation and administration of the plan; resolving internal grievances; and undertaking medical review, legal, and auditing functions. For example, the Fund may use PHI to determine the most cost-effective manner of providing vision benefits to its participants and beneficiaries.

May the Fund disclose my PHI to third-parties? Yes, the Fund may disclose your PHI to third parties that assist the Fund in its operations. For example, the Fund may share your PHI with its business associates if the business associate is responsible for paying medical claims for the Fund. The Fund’s business associates have the same obligation to keep your PHI confidential as the Fund does.

May the Fund use my PHI for purposes besides treatment, payment and health care operations? Yes. the Fund may use your PHI for other purposes, including informing you of treatment alternatives or other health-related benefits that may be of interest to you.

May I call the Fund to get information about my children’s health claims? The Fund will provide a minor child’s parent, guardian (or person standing in loco parentis with respect to the child) with payment information about the child’s claim. The Fund will carefully consider your written request for information other than claims payment information and will respond as permitted by these privacy policies and applicable state law. NOTE: If your child is not a minor, the Fund generally cannot provide you with the child’s PHI without their authorization, even if the child is still covered under this Fund as your dependent.

Does HIPAA permit the Fund to disclose my PHI to my employer or insurer? The Fund generally cannot disclose your PHI to your employer without your written authorization. The Fund may disclose your PHI without your authorization to workers’ compensation insurers, state administrators, or others involved in the workers’ compensation systems to the extent the disclosure is required by state or other law.

May the Fund release my PHI to the Fund’s plan sponsor? The Fund may disclose information to the “plan sponsor” for administrative functions. Here, the “plan sponsor” is the Fund’s Board of Trustees. The Fund may provide summary health information to the plan sponsor so that the plan sponsor may solicit premium bids or modify, amend, or terminate the plan.

May the Fund release my PHI to law enforcement or other governmental entities? Your PHI may be disclosed to law enforcement agencies, without your authorization or permission, to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting, including information related to victims of abuse, neglect, or domestic violence. Note, however, that the Fund may not disclose your PHI if you are the subject of an investigation that does not arise out of or is directly related to your receipt of health care or public benefits. In addition, the Fund may disclose your PHI in the course of a judicial or administrative proceeding if the Fund receives a court order, subpoena, discovery request or other lawful process. Before releasing this information, the Fund will make reasonable efforts either to notify you or to obtain an order protecting your PHI.

Would the Fund release my PHI if my health or safety or public health or safety would be jeopardized if it did not? The Fund may disclose your PHI if there is a threat to the health or safety of you, any other person, or the public, pursuant to applicable law. Your PHI may also be disclosed for public health activities, such as preventing or controlling disease or disability.

In what other ways may the Fund use or disclose my PHI without my authorization? The Fund may use or disclose your PHI without your authorization in the following ways:

• For government functions, such as intelligence, national security activities, and protection of public officials. Your PHI also may be disclosed to health agencies to assist with monitoring the health system for audits, investigation, licensure, or other oversight activities;
• To comply with laws related to military service or veteran’s affairs;
• For research purposes, so long as your PHI is protected as required by the applicable law;
• To a family member or close personal friend involved in your care in the event of an emergency, or to a disaster relief entity in the event of a disaster
• To an organ donor or organization that helps with organ or tissue donation; and
• To coroners, medical examiners, and funeral directors so that they can perform their jobs.

Must the Fund have an authorization to release my PHI? Yes. For example, the following uses and disclosures of your PHI will be made only with your written authorization:

• Uses and disclosures for marketing purposes;
• Uses and disclosures of psychotherapy notes (where applicable); or
• Uses and disclosures that constitute the sale of PHI;

Any other disclosure or use of your PHI for any other purpose not described in this Notice requires your written authorization. This means that if you want your friend, relative, or union representative to check on the status of a claim you submitted or to advise when or if payment will be made, you must sign an authorization form and submit it to the Fund Office. If you change your mind after authorizing a use or disclosure of your PHI, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you provided written notice to the Fund of your decision to revoke the authorization.

May the Fund use or disclose my genetic information for underwriting purposes? No. The Fund is prohibited from using or disclosing genetic information for underwriting purposes.

Can the Fund disclose my substance use disorder patient records? The Fund will comply with Part 2 regarding the confidentiality of your substance use disorder patient records to the extent the Fund receives, maintains or transmits such records, ensuring that disclosures are made only as permitted by law. Specifically, any substance use disorder treatment records received from programs subject to Part 2, or testimony relaying the content of such records, will not be used or disclosed in civil, criminal, or legislative proceedings against you unless based on written consent, or a court order after notice and opportunity to be heard have been provided to you or the holder of the records, as required in Part 2.  A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirements compelling disclosure before the required record is used or disclosed.

Separately, if the Fund creates or maintains records subject to Part 2 and intends to use or disclose such records for fundraising purposes for the benefit of the Fund, prior to the use and disclosure you will be provided with a clear and conspicuous opportunity to elect not to receive any fundraising communications.

Do I have the rights under the federal privacy standards? Your rights to information under HIPAA include:

• The right to request restrictions on the use and disclosure of your PHI. The Fund will carefully consider, although is not required to honor, your request for restrictions;
• The right to restrict confidential communications concerning your medical conditions or treatment if you believe that disclosure of this information could endanger you (this means, for example, that you can make a written request that the Fund send information about your medical treatment to a post office box or an address different from your home address in order to ensure that your PHI remains confidential). The Fund will attempt to honor reasonable requests;
• The right to opt out of receiving fundraising communications prepared for the Fund;
• The right to inspect and copy your PHI. The Fund may charge a reasonable fee for copying, assembling and postage;
• The right to an electronic copy of electronic medical records. The Fund will make every effort to provide access to PHI in the form or format you request, if it is readily producible in such form or format;
• The right to get notice of a breach of any of your unsecured PHI;
• The right to amend or submit corrections to your PHI. If you believe that the information in your records is inaccurate or incomplete, you may submit a written request to correct these records. The Fund may deny your request if, for example, you do not include the reason you wish to correct your records or if the records were not created by the Fund;
• The right to receive an accounting of how and to whom your PHI has been disclosed if it was disclosed for reasons other than treatment, payment or health care operations. Your written request for information must be submitted to the Fund and should state the period of time for which you are requesting an accounting. The first accounting that you request with a twelve-month period will be free;
• The right to file a complaint that your privacy rights have been violated to the Fund and to the Secretary of U.S. Department of Health & Human Services. To file a complaint with the Fund, you may submit your complaint in writing to the Privacy Officer listed below. To file a complaint with the Department of Health and Human Services, you may either send a letter to 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201; call 1-800-368-1019, or submit a complaint online at www.hhs.gov/ocr/privacy/hipaa/complaints. NOTE: you will not be penalized or otherwise retaliated against for filing a complaint;
• The right to receive a printed copy of this Notice. You can find this Notice and authorization forms for release of PHI on the Fund’s website at www.centralpateamsters.com. The link to the authorization form is available by clicking on the link below:

Complaints? Comments? Requests? The Fund has designated Cherie Freeman, Health and Welfare Benefits’ Manager as the Privacy Officer. If you wish to request information which you have a right to receive, want to file a Complaint with the Fund or if you have any comments or questions regarding this notice, please contact Cherie Freeman, Health and Welfare Benefits’ Manager. Please note that the Fund can assess reasonable charges for copying and assembling documents you request as well as for postage.