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April 14, 2003
This notice explains how medical information about you may be used and
disclosed and how you can get access to this information. Please review it
carefully.
The practices outlined in this notice take effect on April 14, 2003.
This notice explains possible uses of certain personal medical information
(called "protected health information") by the Curtiss-Wright
Corporation Group Benefits Plan (called the "plan") and how you can
get access to it for your own review. The practices, rights and duties described
in this notice apply only to the medical, Rx, dental, and health care spending
account portions of the plan.
The plan is required by law to maintain the privacy of your protected health
information and to inform you about:
- The plan's practices regarding the use and disclosure of your protected
health information;
- Your rights with respect to your protected health information;
- The plan's duties with respect to your protected health information;
- Your right to file a complaint with the plan and with the Secretary of
the U.S. Department of Health and Human Services; and
- Whom you may contact for additional information about the plan's privacy
practices.
The plan will follow the terms of this notice, as it may be updated from time
to time.
Doctors’ offices, hospitals, and other health care providers may have
different policies and procedures regarding the use and disclosure of the
protected health information they maintain. For information about their policies
and procedures, contact them directly.
Any person who assists in the administration of the plan will follow the
privacy practices described in this notice.
If you are enrolled in an insured HMO option, you will receive a similar
notice of privacy practices from the HMO that provides that coverage.
How the Plan
May Use your Protected Health Information
The plan may use or disclose your protected health information for the
reasons listed below. It will not use or disclose it for any other reasons
without your prior written authorization, which you may revoke at any time
(subject to certain limitations).
- For treatment—
to provide, coordinate, and manage health care and
related services you receive from your health care providers.
Example: The plan administrator might inform your pharmacist about
medications you are taking. This information enables your pharmacist to
determine whether there may be an adverse interaction with a new prescription.
- For payment—
to determine eligibility for benefits, to facilitate
payment to health care providers, to determine benefit responsibility, to
coordinate coverage, and to handle other related responsibilities including
billing, claims management, and utilization or precertification review.
Example: The plan may tell your doctor or hospital whether you are
eligible for coverage or what percentage of your bill the plan will pay.
- For operation of the plan—
to assess and improve the quality of
services, to estimate the cost of future coverage, and to carry out other
activities relating to insurance contracts, disease management, case
management, medical review, legal services, and audits.
Example: The plan may use information about your medical claims to
refer you to a disease management program, to estimate future benefit costs,
or to make sure that claims are accurately processed.
- As required by law
—to comply with federal, state,
or local laws.
- For reporting public health risks—
to prevent a serious threat
(disease, injury, or disability) to your health and safety or the health and
safety of the public or another person.
Examples:
- Reporting child abuse or neglect
- Reporting reactions to medication or problems with products under federal
regulation
- Notifying people who are exposed to a communicable disease or who may be
at risk of contracting or spreading a disease
- Notifying the appropriate government agency if the plan believes that a
covered person is victim of abuse, neglect, or domestic violence (only if
that person agrees to it or when it is required or authorized by law).
- For health care oversight activities
authorized by law—to
support audits, investigations, inspections, licensure or disciplinary
actions, and other governmental efforts to monitor the health care system,
government programs such as Medicare and Medicaid, and compliance with civil
rights laws.
Example: The plan may provide medical information to a government
health oversight agency investigating complaints against physicians or other
health care providers.
- In connection with lawsuits or other disputes
—to respond
to a court order, subpoena, discovery request, or other lawful proceeding in
which you are involved. However, the plan will release the information only if
it receives satisfactory assurances from the requesting party that it made a
good faith attempt to give you written notice of the proceeding that included
sufficient information to permit you to object to the disclosure before the
court or tribunal, and you either did not file an objection or you filed an
objection but the court or tribunal ruled against you.
- For law enforcement purposes
—
- To respond to a court order, subpoena, warrant, summons or similar process
- To help identify or locate a suspect, fugitive, material witness, or
missing person
- To assist in an investigation into criminal conduct at a health care
facility
- To assist in the investigation of a crime in which you are the victim or
suspected victim
- To assist in the investigation of a death suspected to be the result of
criminal conduct.
- For national security and intelligence activities
—to respond to
the requests of authorized federal officials for intelligence,
counter-intelligence, and other national security activities authorized by
law.
- For the duties of a coroner, medical examiner, or funeral director
—to
identify the body of a deceased person, to determine a cause of death, or to
perform other authorized duties.
- For facilitating organ donation and transplants—
to release
necessary medical data to organizations engaged in the procuring,
banking, or transplanting of human organs, eyes, or tissue.
- To comply with workers' compensation laws
or other similar
programs to the extent necessary.
- To facilitate care you receive from a family member, relative, friend, or
other person
—the plan may give your health information to a
caregiver you designate to receive it, as long as the information directly
relates to that person's involvement with your care or payment for that care.
The plan will do this only if you have either agreed to that disclosure, or
you have had the chance to object but did not do so. If you are physically or
mentally incapable of agreeing with or objecting to this use of your health
information, the plan will act in what it believes to be your best interest.
- To advise you of treatment alternatives
—to provide
information about treatment alternatives or other health-related benefits or
services that may be of interest to you.
Example: The plan may contact you to provide
information about treatment alternatives or other health-related benefits or
services that may be of interest to you.
- To Plan Sponsor
—for purposes of administering the plan. The plan
may also disclose your health information to another health plan sponsored by
the employer for purposes of treatment, payment or health care operations of
that health plan.
Your Rights Regarding Your Protected Health Information
As a participant in the plan, you have the following rights regarding the
protected health care information maintained by the plan. You may exercise these
rights by submitting a written request to: Curtiss-Wright Corporation, 4 Becker
Farm Road, Roseland, NJ 07068, attention: Carol Brigian
- The right to inspect and copy
your protected health
information. You may inspect or obtain a copy of your protected health
information that is used by the Plan for enrollment, payment, claims
adjudication, or case management, or that is used by the Plan to make decisions
about you. You will not be given access to information that was compiled in
connection with a lawsuit, or psychotherapy notes.
If the plan has on-site access to the information, you will receive it within
30 days. If it is maintained offsite, you will receive it within 60 days. One
30-day extension is permitted if, within the original 30- or 60-day period, the
plan gives you the reason for the delay and tells you when you can expect to
receive the information. In the rare situation where the plan must deny your
request, you will be notified in writing.
The plan may charge a reasonable fee for copying, mailing, and other services
related to your request.
- The right to amend your protected health information.
If any of the
health information that you have the right to inspect is incomplete or
inaccurate, you may submit a written request for amendment of that
information. Generally the plan will respond to your request within 60 days. One
30-day extension is permitted if, within the original 60-day period, the plan
gives you the reason for the delay and tells you when the plan will act upon
your request.
The plan may deny your request if it is not in writing or if it does not
include a valid reason supporting the request. The plan may also deny the
request if you ask it to amend information that was not created by the plan,
unless you provide a reasonable basis to believe that the person or entity that
created it is no longer available to make the amendment. Finally, your request
may be denied if the health information you wish to amend is one of the data
items that you are permitted to inspect and copy (see item 1, above), or is
accurate and complete.
If the plan denies all or part of your amendment request, you will be
notified of the denial and your related rights in writing.
- The right to receive an accounting of disclosures.
You may request
an accounting of disclosures made by the plan during the six years prior to your
request. However, the accounting will not include disclosures of health
information that were made:
- For purposes of treatment, payment, or health care operations
- To you
- Pursuant to an authorization
- Before April 14, 2003.
Generally the plan will respond within 60 days after your request is
received. One 30-day extension is permitted if, within the original 60-day
period, the plan gives you the reason for the delay and tells you when the
plan will act upon your request.
If you request more than one accounting in a 12-month period, the plan will
charge a reasonable fee for each additional accounting.
- The right to request restrictions
. You may ask the plan to
restrict or limit the use or disclosure of your protected health information
for purposes of payment, treatment, and health care plan operations or its
disclosure to family members, friends, or others involved with your care or
payment for your care. However, the plan is not required to honor this
request.
The written request must describe the information you want to limit. It
must also say whether you want to limit the plan' use, disclosure or both, and
include the names of the individuals or organizations to which the limitations
or restrictions should apply (your spouse, for example).
- The right to request confidential communications related to your protected
health information.
You may request that confidential communications
to be sent to you in a certain way or to a certain location.
Example: You may request that an Explanation of Benefits be mailed to
your workplace rather than to your home.
- The right to receive another paper copy of this notice at any time.
You may also download a printable copy of this notice from the Sponsor’s
Internet site at www.curtisswright.com.
Your
Personal Representative
Generally, your personal representative has the same rights regarding your
protected health information as you have. The plan will afford your personal
representative these rights only if he or she presents evidence of authority to
act on your behalf. Evidence of authority means a notarized power of attorney
for health care purposes or a court order that appoints the person to be your
conservator or guardian. The plan considers the parent of a minor child to be
the child's personal representative.
The plan may refuse to recognize someone as your personal representative if
they believe there is good reason to believe that it is not in your best
interest to give that person access to your protected health information.
Changes to This Notice
The plan reserves the right to change the terms of this notice and to apply
any new rules or procedures to all protected health information it maintains now
or in the future. Revised notices will be distributed within 60 days of the
effective date of any material change to uses and disclosures, individual
rights, legal duties, or other privacy practices. A copy of the current notice
will also be posted at www.curtisswright.com.
If You Have
Complaints
If you believe that your privacy rights have been violated, you may file a
complaint with the plan by writing to: Curtiss-Wright Corporation, 4 Becker Farm
Road, Roseland, NJ 07068, attention: Paul Ferdenzi, Esq.. You may also file a
written complaint with the:
Region II, Office for Civil Rights
US. Department of Health and Human Services
Jacob Javits Federal Building
26 Federal Plaza
Suite 3312
New York, NY 10278
Complaints may also be sent by email to: OCRComplaint@hhs.gov. No one is allowed to retaliate against you for filing a complaint.
If You Need More Information
If you have any questions or need more information about this notice, contact
Curtiss-Wright Corporation, 4 Becker Farm Road, Roseland, NJ 07068, attention:
Carol Brigian.
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