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.

I.	Your Privacy Notice.
	This is your Health Information Privacy Notice from the Shelby County Government self-insured group plans. Please read it carefully. You have received this notice because as a group health plan we are required by Federal law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices. We strongly believe in protecting the confidentiality and security of information we collect about you.
II.	Our Duty to Safeguard Your Protected Health Information.
	Individually identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for the health care is considered "Protected Health Information" ("PHI"). We are required to extend certain protections to your PHI, and to give you this Notice about our privacy practices that explains how, when and why we may use or disclose your PHI. Except in specified circumstances, we must use or disclose only the minimum necessary PHI to accomplish the purpose of the use or disclosure. We are required to follow the privacy practices described in this Notice, though we reserve the right to change our privacy practices and the terms of this Notice at any time. If we do so, we will post a new Notice on Official Bulletin Boards at Work Locations. You may request a copy of the new notice from Brenda Greene, Privacy Official, at (901) 545-4939 and it will also be posted on our website at www.shelbycountytn.gov.
III.	How We May Use and Disclose Your Protected Health Information.
	We use and disclose PHI for a variety of reasons. Federal law provides that we are permitted to make some uses/disclosures without your consent or authorization. For most uses/disclosures, we must obtain your consent. For others, we must have your written authorization. The following offers more description and examples of our potential uses/disclosures of your PHI.
		Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations.  Federal law allows a group health plan to use and disclose PHI for the purposes of treatment, payment and health care operations without your consent or authorization. Examples of the uses and disclosures that we, as a group health plan, may make under each section are listed below: For treatment: Treatment refers to the provision and coordination of health care by a doctor, hospital or other health care provider. As a group health plan, we do not provide treatment. To obtain payment: Payment refers to the activities of a group health plan in collecting premiums and paying claims under the plan for health care services you receive. Examples of uses and disclosures under this section including the sending of PHI to an external medical review company to determine the medical necessity or experimental status of a treatment; sharing PHI with other insurers to determine coordination of benefits or settle subrogation claims; providing PHI as required for pre-certification or case management services; providing PHI in the billing, collection and payment of premiums and fees to plan vendors such as PPO networks, prescription drug card companies and reinsurance carriers; and sending PHI to a reinsurance carrier to obtain reimbursement of claims paid under the plan. Additionally, we may disclose PHI for various payment-related functions, such as eligibility determination, audit and review, or to assist you with your inquiries or disputes. For health care operations: We may use/disclose your PHI in the course of operating our group health plans. For example, we may use your PHI in evaluating a request for services, administering those services, and processing transactions requested by you. We may also use your PHI in evaluating the quality of services provided, or disclose your PHI to our accountant or attorney for audit purposes. We may also disclose PHI to business associates outside of Shelby County Government if they need to receive PHI to provide a service to us and will agree to abide by specific HIPAA rules relating to the protection of PHI. Examples of business associates are: billing companies, data processing companies, or companies that provide general administrative services. PHI may also be disclosed to reinsurers for underwriting, audit or claim review reasons.
		Other Uses and Disclosures Allowed Without Authorization.  Federal law also allows a group health plan to use and disclose PHI, without your consent or authorization, in the following ways: To you or a personal representative designated by you: We may disclose PHI to you as the covered individual. We may also disclose PHI to a personal representative designated by you to receive PHI or a personal representative designated by law such as the parent or legal guardian of a child, or the surviving family members or representative of the estate of a deceased individual. To the Secretary of Health and Human Services: We may disclose PHI to the Secretary of Health and Human Services (or any employee of HHS) as part of any investigation to determine our compliance with the HIPAA Privacy Rules. To a Business Associate: We may disclose PHI to a business associate as part of a contracted agreement to perform services for the group health plan. When required by law or for Public Health Activities: We may disclose PHI when a law requires that we report information. Examples of such required reporting include notifying state or local health authorities regarding certain communicable diseases, or providing PHI to a governmental agency or regulator with health care oversight responsibilities. We may also release PHI to a coroner or medical examiner to assist in identifying a deceased individual or to determine the cause of death. To avert a Serious Threat to Health or Safety: We may disclose PHI to avert a serious threat to someone's health or safety. We may also disclose PHI to federal, state or local agencies engaged in disaster relief as well as to private disaster relief or disaster assistance agencies to allow such entities to carry out their responsibilities in specific disaster situations. For Health-Related Benefits or Services: We may use PHI to provide you with information about benefits available to you under your current coverage and, in limited situations, about health-related products or services that may be of interest to you. For Law Enforcement or Specific Government Functions: We may disclose PHI in response to a request by a law enforcement official made through a court order, subpoena, warrant, summons or similar process. We may disclose PHI about you to federal officials for intelligence, counter-intelligence and other national security activities authorized by law. When Requested as Part of a Regulatory or Legal Proceeding: We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process pursuant to legal proceeding. We may disclose PHI to any governmental agency or regulator with whom you have filed a complaint or as part of a regulatory agency examination. To the Plan Sponsor (Shelby County Government): We may disclose PHI to Shelby County Government as necessary to carry out the administrative functions of the plan such as evaluating renewal quotes for reinsurance of the plan, funding check registers, reviewing claim appeals, approving subrogation settlement and evaluating the performance of the plan. The examples of permitted uses and disclosures listed above are not provided as an all-inclusive list of the ways in which PHI may be used. They are provided to describe in general the types of uses and disclosures that may be made.
		Other Uses and Disclosures of PHI: Other uses and disclosures of PHI will be made only with your written authorization or that of your legal representative. If we are authorized to use or disclose PHI about you, you or your legally authorized representative may revoke that authorization, in writing, at any time, except to the extent we have taken action relying on the authorization. You should understand that we will not be able to take back any disclosures we have already made with authorization.
IV.	Your Rights Regarding Your Protected Health Information.  You have the following rights relating to your protected health information: To request restrictions on uses/disclosures: You have the right to ask that we limit how we use or disclose your PHI. While we will consider your request, we are not required to agree to it. To the extent that we do agree, we will comply with your request. To request a restriction, you must make your request in writing to the administrator set forth below. You must tell us in your request (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 (for example, disclosures to your spouse or parent). We cannot agree to limit uses/disclosures that are required by law or are necessary to administer our group health plan. To choose how we contact you: You have the right to ask that we send you information at an alternative address or by an alternative means. Any such request must be in writing to the administrator set forth below. We will accommodate all reasonable requests. To inspect and copy your PHI: In most cases, you have a right to inspect and obtain a copy of your protected health information if you put your request in writing to the person designated below. If you want copies of your PHI, a charge for copying may be imposed, but may be waived, depending on your circumstances. You have a right to choose what portions of your information you want copied and to have prior information on the cost of copying. Certain types of PHI will not be available for inspection and copying. This includes PHI collected by us in connection with, or in reasonable anticipation of, any claim or legal proceeding. In very limited circumstances we may deny your request to inspect and obtain a copy of your PHI. If we do, we will give you written reasons for the denial and explain any right to have the denial reviewed. To request amendment of your PHI: If you believe that there is a mistake or missing information in our record of your PHI, you may request that we correct or add to the record. Your request and the reason for your request must be submitted in writing to the administrator set forth below. We may deny the request if it is not in writing and does not include a reason for the request. In addition, we may deny the request if we determine that the PHI is: (i) correct and complete; (ii) not created by us and/or not part of our records, or; (iii) not permitted to be disclosed. Any denial will state the reasons for denial and explain your rights to have the request and denial, along with any statement in response that you provide, and will be appended to your PHI. If we approve the request for amendment, we will change the PHI and so inform you, and tell others that need to know about the change in the PHI. To find out what disclosures have been made: You have a right to get a list of when, to whom, for what purpose, and what content of your PHI has been released. This list will not contain instances of disclosure for which you gave consent (i.e. for treatment, payment, operations, to you, your family, or a member directory). The list also will not include any disclosures made for national security purposes, to law enforcement officials or correctional facilities, or before April 14, 2003. Your request can relate to disclosures going as far back as six years. There will be no charge for up to one such list each year. There may be a charge for more frequent requests. To receive this notice: You have a right to receive a paper copy of this Notice upon request. This right applies even if you have previously agreed to accept this Notice electronically.
V.	How to Complain about our Privacy Practices: If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed in Section VI below. You also may file a written complaint with the Secretary of the U.S. Department of Health and Human Services at Region IV, Office for Civil Rights, U.S. Department of Health and Human Services, Atlanta Federal Center, Suite 3B70, 61 Forsyth Street, SW., Atlanta, GA 30303-8909. Voice Phone (404) 562-7886. FAX (404) 562-7881. TDD (404) 331-2867. You will not be penalized for filing a complaint.
VI.	Contact Person for Information:
	If you have questions about this Notice or our privacy practices, please contact: Brenda Greene Manager, Employee Benefits Shelby County Government 160 North Main, Suite 949 Memphis, TN 38103 (901) 545-4939 brenda.greene@shelbycountytn.gov
VII.	Contact Persons to Submit a Complaint: If you have any complaints about our privacy practices, please contact: Brenda Robinson Supervisor, Employee Benefits Shelby County Government 160 North Main, Suite 949 Memphis, TN 38103 (901) 545-4953 brenda.robinson@shelbycountytn.gov
VIII.	Effective Date: This Notice becomes effective on April 14, 2003.