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Notice of Privacy Practices

Effective January 1, 2022

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices ("Notice") applies to certain of DEVOTED HEALTH, INC.'s subsidiaries and related entities. These entities have designated themselves as an "Affiliated Covered Entity" for purposes of compliance with federal privacy laws, e.g., HIPAA. An Affiliated Covered Entity is a group of health plans and/or healthcare providers under common ownership or control that designates themselves as a single entity for purposes of compliance with HIPAA. These entities are collectively referred to as “Devoted Health” in this Notice. Devoted Health is required by law to maintain the privacy of your health information in accordance with applicable federal and state law. This Notice outlines our legal duties and privacy practices with respect to health information with respect to the following Devoted Health entities:

DEVOTED HEALTH INSURANCE COMPANY;
DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA, INC.;
DEVOTED HEALTH PLAN OF ALABAMA, INC.;
DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.;
DEVOTED HEALTH PLAN OF ARIZONA, INC.;
DEVOTED HEALTH INSURANCE COMPANY OF COLORADO;
DEVOTED HEALTH PLAN OF COLORADO, INC.;
DEVOTED HEALTH INSURANCE COMPANY;
DEVOTED HEALTH PLAN OF FLORIDA, INC.;
DEVOTED HEALTH INSURANCE COMPANY OF HAWAII, INC.;
DEVOTED HEALTH PLAN OF HAWAII, INC.;
DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS, INC.;
DEVOTED HEALTH PLAN OF ILLINOIS, INC.;
DEVOTED HEALTH PLAN OF NORTH CAROLINA, INC.;
DEVOTED HEALTH PLAN OF OHIO, INC.;
DEVOTED HEALTH PLAN OF OREGON, INC.;
DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA, INC.;
DEVOTED HEALTH PLAN OF PENNSYLVANIA, INC.;
DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA;
DEVOTED HEALTH PLAN OF SOUTH CAROLINA, INC.;
DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE, INC.;
DEVOTED HEALTH PLAN OF TENNESSEE, INC.;
DEVOTED HEALTH INSURANCE COMPANY OF TEXAS;
DEVOTED HEALTH PLAN OF TEXAS, INC.;
DEVOTED MEDICAL GROUP, INC.;
DEVOTED MEDICAL GROUP, PC;
DEVOTED MEDICAL, PC OF ILLINOIS;
DEVOTED MEDICAL, PC OF NORTH CAROLINA;
DEVOTED MEDICAL, PC OF PENNSYLVANIA;
DEVOTED MEDICAL GROUP OF TEXAS, INC.;
DEVOTED MEDICAL GROUP, INC.;
DEVOTED MEDICAL GROUP, PC;
DEVOTED MEDICAL, PC OF ILLINOIS;
DEVOTED MEDICAL, PC OF NORTH CAROLINA;
DEVOTED MEDICAL, PC OF PENNSYLVANIA; and
DEVOTED MEDICAL GROUP OF TEXAS, INC.

We Are Legally Required to Safeguard your Protected Health Information

We are required by law to:

We reserve the right to change our privacy practices and the terms of this Notice at any time. If we make any material change in our practices, we will change this Notice and post the new Notice on our website. Any new terms of our Notice will be effective for all of your information, including information that we create or receive before we make any change. Each version of the Notice will have an effective date. We will provide a copy of the new Notice (or information about the changes and how to obtain the new Notice) in our next annual mailing to members or patients who we cover at that time. You may also obtain a copy of the revised Notice upon request, by contacting us using the information listed at the end of this Notice.

How We May Use and Disclose Your Protected Health Information

The law permits us to use and disclose your PHI for certain purposes without obtaining your written authorization. This Section gives examples of each of these circumstances.

Uses and Disclosures for Treatment, Payment, and Healthcare Operations

Disclosures to the Sponsor of Health Plans

Your health plan contracts with us to provide certain medical services to you. We may disclose your PHI to your health plan sponsor for treatment, payment, and health plan operations and administration. For example, we may provide your health plan with certain data to ensure we are providing quality care to you.

Uses and Disclosures That Require Us to Give You the Opportunity to Object

If you verbally agree to the use or disclosure of your PHI, and in certain other situations, we may make the following uses and disclosures of your PHI. We may disclose certain PHI to your family, friends, and anyone else whom you identify as involved in your healthcare or who helps pay for your care; the PHI we disclose would be limited to the PHI that is relevant to that person's involvement in your care or payment for your care. We may also make these disclosures after your death as authorized by applicable law unless doing so is inconsistent with any prior expressed preference.

We may use or disclose your PHI to notify or assist in notifying a family member, personal representative, or any other person responsible for your care regarding your location, general condition, or death. We'll also use or disclose your PHI to public health authorities who are permitted or required to collect or receive this information for the purposes of controlling disease, injury, or disability. If directed by that health authority, we'll also disclose your health information to a foreign government agency that is collaborating with the public health authority.

Other Uses and Disclosures

HIPAA also allows us to disclose PHI without your authorization in the following circumstances:

Please be aware that state and other federal laws may have additional requirements that we must follow or may be more restrictive than HIPAA on how we use and disclose certain of your PHI. If there are specific more restrictive requirements, even for some of the purposes listed above, we may not disclose your PHI without your written permission as required by such laws. For example, we may be required by law to obtain your written permission to use and/or disclose your mental illness, developmental disability, or alcohol or drug abuse treatment records, reproductive health, HIV, STD, or other communicable disease related information, or your genetic test results in certain situations.

Uses and Disclosures Requiring Your Authorization

We must obtain your written authorization to use or disclose your PHI in circumstances not described above, including for marketing activities or before your PHI is sold. 

If you give us written authorization for a use or disclosure of your PHI, you may revoke that authorization, in writing, at any time. If you revoke your authorization we will no longer use or disclose your PHI for the purposes specified in the written authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of your PHI that occurred before you notified us of your decision, any actions that we have taken based upon your authorization, or if your authorization was obtained as a condition to your obtaining insurance coverage and the law permits us to contest a claim or the policy. To revoke an authorization, make a written request to our Privacy Officer, using the contact information below.  

Your Rights Regarding Your Protected Health Information 

You have the following rights regarding your PHI.
All requests or communications to us to exercise your rights discussed below must be submitted in writing to the Privacy Officer at the contact information listed below. 

The Right to Choose How We Communicate With You.
You have the right to ask that we send information to you at a specific address (for example, at work rather than at home) or in a specific manner (for example, by email rather than by regular mail, or never by telephone). We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not. 

The Right to See and Copy Your PHI.
Except for limited circumstances (e.g., information contained in psychotherapy notes or information gathered in anticipation of use in a civil, criminal, or administrative proceeding), you may look at and copy your PHI if you ask in writing to do so. You may ask for a paper copy or, if your PHI is maintained electronically, an electronic copy of your PHI, and you may ask that the copy be sent to someone that you designate. We will respond to your request within 30 days (or 60 days if extra time is needed). In certain situations we may deny your request (e.g., if it is reasonably likely to put you or someone else in danger), but if we do, we will tell you in writing of the reasons for the denial and explain your rights with regard to having the denial reviewed. We may charge you a fee authorized by law to meet your request. Alternatively, we may provide you with a summary or explanation of your PHI, as long as you agree to that and to the cost, in advance. 

The Right to Correct or Update Your PHI.
If you believe that the PHI we have about you is incomplete or incorrect, you may ask us to amend it. Any such request must tell us why you think the amendment is appropriate. We will act on your request within 60 days (or 90 days if extra time is needed), and will inform you in writing as to whether the amendment will be made or denied. If we agree to make the amendment, we will make reasonable efforts to notify other parties that we know have your PHI of the amendment. If we agree to make the amendment, we will also ask you whom else you would like us to notify of the amendment. Under certain circumstances we may deny your request. If your request is denied, we will provide you with information about our denial and how you can file a written statement of disagreement with us that will become part of your record. 

The Right to Get a List of the Disclosures We Have Made.
You have the right to request an accounting of disclosures we make of your PHI. Please note that certain disclosures need not be included in the accounting we provide to you (such as disclosures made for payment, treatment, or healthcare operations or for uses or disclosures otherwise permitted or required by law). Your request must state a time period which may not go back further than six years. You will not be charged for this accounting, unless you request more than one accounting per year, in which case we may charge you a reasonable cost-based fee for providing the additional accounting(s). We will notify you of the costs involved and give you an opportunity to withdraw or modify your request before any costs have been incurred. We will respond to your request within 60 days (or 90 days if extra time is needed). 

The Right to Request Limits on Uses and Disclosures of Your PHI.
You have the right to request that we limit how we use or disclose your information. Except under limited circumstances, we are not required to agree to your request, but if we do, we will abide by our agreement (except in an emergency). 

The Right to Get a Paper Copy of This Notice.
Even if you have agreed to receive this Notice by email, you have the right to request a paper copy as well. You may obtain a paper copy of this Notice by contacting the Privacy Officer using the contact information below. You may also visit our website at
www.devoted.com/privacy-practices.  

Complaints 

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the federal Department of Health and Human Services Office of Civil Rights. To file a complaint with us, you must make that complaint in writing and send it to our Privacy Officer using the contact information below. We will not retaliate against you for filing a complaint. You may also contact our Privacy Officer if you have questions or comments about our privacy practices. 

FOR MORE INFORMATION ABOUT ANY OF OUR PRIVACY PRACTICES, TO EXERCISE YOUR PRIVACY RIGHTS, OR TO FILE A COMPLAINT, CONTACT OUR PRIVACY OFFICER AT: 

Paul Jernigan, Privacy Officer
c/o Devoted Health, Inc.
PO Box 21327
Eagan, MN 55121
1-800-338-6833 (TTY 711)