Notice of Privacy Practices of the Health & Welfare Fund of the Patrolmen's Benevolent Association of the City of New York and Retiree Health & Welfare Fund of the Patrolmen's Benevolent Association of the City of New York

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.

The Health and Welfare Fund of the Patrolmen's Benevolent Association of the City of New York and the Retiree Health and Welfare Fund of the Patrolmen's Benevolent Association of the City of New York, collectively the "Funds", are dedicated to protecting the privacy of all personal health information collected and maintained about its members and their dependents in the course of providing benefits and services to them.  We have a comprehensive privacy program in place that meets the requirements of the Health Insurance Portability and Accountability Act ("HIPAA") Privacy Regulations, the government legislation that sets standards for the privacy of your health information. 

We are providing you with this notice to inform you about the ways that we may use and disclose your personal health information for the purposes of providing benefits and services and about your rights regarding your personal health information.  Personal health information means any information that identifies you, or that could be reasonably expected to be able to identify you, that relates to:

• your past, present, or future physical or mental condition;

• the provision of health care; or

• the past, present, or future payment for the provision of health care.

• We may disclose personal health information to our business associates, who are third parties that perform services on our behalf, such as accounting, consulting, legal, and administrative services.  We require our business associates to provide us with contractual assurances that they will also safeguard the privacy of your personal health information.

• We may disclose personal health information to law enforcement officials as required.

• We may disclose personal health information in connection with civil legal proceedings pursuant to a court order or as otherwise required or permitted by law.

• We may disclose personal health information to government agencies as required or permitted by law for purposes of the regulation of insurance or employee benefits or in the interest of public welfare.

• We may disclose personal health information to other people you identify who are involved in your health care, such as a relative or friend to the extent necessary to help you with your health care or with payment for your health care.  You may request that we restrict or stop these disclosures by contacting the Funds Administrator's Office.

• We may disclose personal health information to the Board of Trustees of the Funds when it is necessary for claims appeals.

• We may use or disclose personal health information to inform you of available Funds benefits or other health related benefits information that may be of interest to you, or to inform you of treatment alternatives.

• Right to Request Restrictions.  You may request restrictions on certain uses and disclosures of your personal health information for the purposes of treatment, payment or health care operations.  You also have the right to request us to restrict disclosures to other people involved in your health care, like a family member or friend.  We are not legally required to agree with your requests, but, if we do, we will abide by our agreement (except in an emergency).  To request restrictions, you must make your request in writing.  In your request, you must tell us:  (a) what information you want to limit; (b) whether you want to limit our use, disclosure or both; and (c) to whom you want the limits to apply, for example, disclosures to your spouse.

• Right to Request Confidential Communications.  You have the right to request that we communicate with you about your personal health information by alternate means or at alternate locations, if you tell us that communication in another manner would endanger you.  For example, you can ask that we only contact you at home or only by mail.  We will accommodate reasonable requests.

• Right to Inspect and Copy Your Personal Health Information.  In most cases, you have the right to inspect and obtain a copy of the personal health information that we may obtain about you.  This information consists of medical and billing records, as well as the enrollment, payment, claims adjudication, and case or medical management record systems or other information used to make decisions about individuals by or for the Funds.  We may ask you to make such requests in writing, and we may charge you a fee for the costs of copying, mailing or other costs associated with your request.   We may deny your request to inspect and copy in certain limited circumstances.  If you are denied access to protected health information, you may request a review of that decision.  Another health care professional will review your request and the denial.  The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review. 

• Right to Amend Your Personal Health Information.  If you believe that your personal health information is incorrect or that an important part of it is missing, you have the right to ask us to amend your personal health information while it is kept by or for us.  You must provide your request and your reason for the request in writing.  We may deny your request if we did not create the information you want amended or for certain other reasons.  If we deny your request, we will provide you a written explanation.  You may respond with a statement of disagreement to be included in the information you wanted amended.  If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.

• Right to a List of Disclosures.  You have the right to receive a list of instances in which we or our business associates disclosed your protected health information for purposes other than treatment, payment, health care operations and certain other activities.  Your request must be in writing and the time period may not be longer than six years and may not include dates before April 14, 2003.  If you request this list more than once in a 12 month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.

• You have the right to request a paper copy of this notice.

Geraldine Hennessy
Funds Administrator
PBA Funds Office
40 Fulton Street - 2^nd Floor
New York, NY 10038

Secretary of Health and Human Services
Department of Health and Human Services
Office for Civil Rights
Hubert R. Humphrey Building
200 Independence Avenue, S.W.
Room 509 F HHH Building
Washington, DC 20201

PBA Funds Office
Office of the Funds Administrator
40 Fulton Street - 2^nd Floor
New York, NY 10038
(212) 349-7560