A federal law says that we must keep facts about your health private. It also says we must give you this notice.

Here are the rules that we must follow to keep facts about your health private. These rules can change. If important changes are made, we will tell you.

Everyone who works with us must agree to follow these rules. This includes people like the employees of:

• TennCare
• The State of Tennessee
• The Federal Government
• Companies that have contracts with the State of Tennessee or the Federal Government
• TennCare Health Plans
• Your Providers

The Facts We Have About You and Your Health

We get information about you so that we may help you get health care. We also need this information to pay for your health care.

We have facts such as:

• A list of all the health services and treatments that you get.
• Notes or records from your doctor, drugstore, hospital or other health care providers.
• Lists of illnesses you now have or have had before.
• Lists of the medicine you take now or have taken before.
• Results from x-rays and lab tests.

This Is How We Get This Information

• From you, on the telephone, or in person.
• From TennCare, information on your TennCare application.
• From your doctors, such as medical history and claims records.

How We Use Facts About Your Health

We must share facts about your health to run our program.

We share facts about your health so you can get the health care you need.

When you applied for TennCare, you did NOT give your OK to share facts about your health with everyone. We will sometimes need your written OK to share these facts.

When we need your OK, we must ask for it on a written form. We call this an authorization form. You can take back the OK that you give us on that form at any time. If you want to take back your OK, you must tell us in writing.

TLC Shares Facts About You Only As The Law Allows

We would share facts about you to:

• To make sure that you get the medical treatment you need.
• To get payment to your health care providers.
• To run and check on our program. This helps us be sure that you get quality care from your health care providers.
• To help if anyone’s health or safety is in danger.
• Prove that you are on TennCare to your providers.
• Check how our health program is working. Your facts may help us find insurance fraud.
• Report cases of abuse or neglect.
• Tell you about appointments and other health information. We may send you reminders for checkups. We may also send you information about health services that may interest you.

• Obey laws on workers’ compensation. We may share facts about you with:

• Your family or others who are involved in your care. You may ask us not to tell them your information. We will agree if we can. If you are a minor child or in an emergency, we might not be able to agree.
• The court when the law says we must or are ordered to do so. If you file a TennCare appeal, we may share facts about you. Other people may also be in court during your appeal hearing.
• Law enforcement or for legal reasons.
• Public health agencies to update records for births and deaths or to track diseases.
• A coroner, funeral home, or people dealing with organ transplants.
• Medical research organizations. They must keep facts about you private. We may also do it if we take out the facts that tell who you are.
• Other government agencies. These would be agencies like those for military and veterans’ activities, national security activities and correctional institutions.

Protection Of Your Health Facts

TLC follows strict guidelines to keep your health facts private.

• TLC has a confidentiality policy that all our employees must sign.
• We also have guidelines that make sure that only TLC employees that need your health facts have access to them.
• We have guidelines that make sure your health facts are used correctly and they are stored and disposed of correctly.
• We have policies and procedures that make sure employees know how and when they should share your health facts when using the telephone.
• All copier machines, printers, and fax machines are in safe and secure areas, and any documents with your health facts are quickly picked up.
• We have guidelines that make sure that your health facts are only faxed to authorized users when needed.
• We have guidelines to make sure that our computers have the right protection to keep your health facts private.

Member Information Shared with the Bureau of TennCare

TLC is required to share information with the Bureau of TennCare. Most commonly this information includes:

• Address and Phone Number information
• Marital Status
• Other Insurance Coverage
• Family Size
• Claims Information as required

TLC only shares this information on an as needed basis. TLC cannot assure how TennCare protects the information we share with them.

Your Health Information Rights

You have the right to:

• See and get copies of your records.

If you want a copy, you must ask for it in writing. We may charge a fee for the cost of copying and mailing. You cannot get a copy of certain facts. If we deny your request, we will send you a letter that tells you why.

• Talk to TLC about how we share your information.
• Ask us to change health information that is wrong.

You must ask us in writing. You must give us a reason why we need to change it. We may not be able to agree to the change. If we cannot make the change, we will send you a letter that tells you why.

• Ask us for a list of who got your health information.

The list will tell you who got your information after April 14, 2003. You must ask us in writing for a copy. The law says that we do not have to give you a list when:

• We have your OK to give it out, or
• We use it to help you get health care, or
• We use it to help with payment for your care, or
• We use it to run our program.

• Ask us not to share certain facts about your health.

You must ask us in writing. You must tell us:

• What facts you do not want shared, and
• With whom you do not want us not to share those facts.

There may be some cases when we cannot agree to your request. If we cannot agree to your request, we will send you a letter that tells you why.

• Take back your OK.

If we ask you to sign an authorization form, you can take it back at any time. You must do it in writing. This will not change any information that we have already shared.

• Ask us to contact you in a different way or in a different place.

You must tell us that you would be put in danger if we kept writing or talking to you about your health in the same place. You must ask in writing.

• Ask for a new notice of our privacy practices. This notice is also on our website at http://www.mmcc-tlc.com

Requests

You must ask in writing if you want TLC to:

• Send you copies of your records.
• Change facts about your health that are wrong.
• Send you a list of who got facts about your health.

Your must also ask in writing if you want to tell TLC that:

• You do not want certain facts about your health shared.
• You are taking back your OK to share facts about you.
• You want to be contacted in a different way or in a different place.

Send your written request to this address. Be sure that your name and social security are on your letter. Keep a copy for your records.

Compliance Specialist TLC Family Care Healthplan 1407 Union Avenue Suite 200 Memphis, TN. 38104

Questions or Complaints

Do you have questions? Do you think that your privacy rights have been violated? If you have a question or a complaint, you can contact one of these offices.

TLC Customer Services 901- 725-7100 (Inside Shelby County) 1-800- 473-6523 (Outside Shelby County)

Office of Civil Rights, Medical Privacy, Complaint Division

U.S. Department of Health and Human Services 200 Independence Avenue, SW, Washington, DC 866 - 627-7748.

You will not be punished if you complain or ask for help.

TLC Does Not Allow Unfair Treatment. No one is treated in a different way because of race, color, birthplace, language, sex, age, or disability.

Thank you for choosing TLC Family Care Healthplan.

Si Ud. tiene alguna pregunta acerca de esta carta, por favor llamar al centro de servicio al cliente de TLC al telefono: 901-725-7100 (Para los que viven dentro del condado de Shelby) 1-800-473-6523 (Para los que viven fuera del condado de Shelby)

Todos los servicios de interpretacion y traduccion son gratis para los afiliadof de TLC.