Notice of Privacy Practices
Effective July 2013
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 purpose of this notice is to:
Provide you with notice of Eyeconic’s information protection practices, and
Explain your rights as an individual about whom Eyeconic maintains information.
Eyeconic is required to abide by the terms of this notice currently in effect by:
Maintaining the privacy of your Protected Health Information,
Notifying you of any breaches of your unsecured Protected Health Information, and
Providing you with notice of our legal duties and privacy practices with respect to Protected Health Information.
Eyeconic reserves the right to revise the terms of this notice, and to make the revised terms effective for all Protected Health
Information that it maintains. If Eyeconic revises this notice, we will make the revised notice available on our website.
A person or entity that uses Protected Health Information to perform a service for Eyeconic. These services may include, but are not limited to:
Health Care Operations
Activities related to Eyeconic’s operations, including but not limited to:
customer issue resolution
Transmission or processing of claims.
Protected Health Information
Information relating to a patient’s past, present or future health or condition, the provision of health care to a patient, or
payment for the provision of health care to a patient. Protected Health Information includes, but is not limited to:
Social Security number/member ID
The provision, coordination or management of vision care and related services by one or more vision care providers.
How EYECONIC Uses and Discloses Information About You
Eyeconic will only use and disclose your Protected Health Information without your authorization when necessary for:
coordination of your vision care treatment
disclosure to your plan sponsor to the extent permitted by law
health care operations, or
as required or permitted by law (please see “Use or Disclosure Required or Permitted by Law” section).
Disclosure to EYECONIC’s Business Associates
Eyeconic will only disclose your Protected Health Information to Business Associates who have agreed in writing to maintain
the privacy of Protected Health Information as required by law.
Use or Disclosure Requiring Authorization
EYECONIC will not use or disclose your Protected Health Information for purposes other than those described in this notice.
If it becomes necessary to disclose any of your Protected Health Information for other reasons, EYECONIC will request your
written authorization. EYECONIC will obtain your authorization for any sale of Protected Health Information, to use or
disclose your Protected Health Information for marketing.
Revoking Authorization: If you provide written authorization, you may revoke it at any time in writing, except to the extent that
EYECONIC has relied upon the authorization prior to its being revoked.
Use or Disclosure Required or Permitted by Law
EYECONIC may use or disclose your Protected Health Information to the extent that the law requires the use or disclosure:
Public Health: For public health activities or as required by the public health authority.
Health Oversight: To a health oversight agency for activities such as audits, investigations and inspections.
Oversight agencies include, but are not limited to, government agencies that oversee the health care system,
government benefit programs, other government regulatory programs and civil rights laws.
Legal Proceedings: In response to an order of a court or administrative tribunal, in response to a subpoena, discovery request or other lawful process.
Law Enforcement: For law enforcement purposes, including:
- legal process or as otherwise required by law;
- limited information requests for identification and location;
- use or disclosure related to a victim of a crime;
- suspicion that death has occurred as a result of criminal conduct;
- if a crime occurs on EYECONIC’s premises; or
- in a medical emergency where it is likely that a crime has occurred.
Criminal Activity: As requested by law enforcement authorities, if the use or disclosure is necessary to prevent
or lessen a serious and imminent threat to the health or safety of a person or the public.
Use and Disclosure Examples
Payment: EYECONIC uses Protected Health Information for payment processing to verify that services provided were covered under the patient’s vision care plan.
Health Care Operations: EYECONIC uses and discloses Protected Health Information to audit and review claims payment activity to ensure that claims were paid correctly.
Treatment: To coordinate treatment by a health care provider.
EYECONIC may disclose your Protected Health Information to a person who has legal authority to make health care decisions on your behalf.
Disclosure Requiring Opportunity to Object
EYECONIC may disclose your Protected Health Information to a family member, friend, or other person involved in your care
or payment if the information is relevant to their involvement and you have agreed or had an opportunity to object.
EYECONIC is prohibited from using or disclosing your genetic information for underwriting purposes.
KNOW YOUR RIGHTS
Exercising Your Rights
You may exercise any of your below rights by sending us a written request.
Review Your Protected Health Information
You have a right to inspect and obtain a copy of your Protected Health Information.
Important: If you feel your Protected Health Information is incomplete or incorrect, you have the right to request that it be amended.
Request to Restrict Your Protected Health Information
You can request restrictions on the use and disclosure of your Protected Health Information. EYECONIC is not required to
agree to a requested restriction.
Example: If a restriction request prevents us from providing service to you or from performing payment related functions, we will not be able to agree to the request.
When necessary, EYECONIC may seek to contact you by calling you at your home or by sending mailings containing your
Protected Health Information to your home. If you feel that such communications could compromise your safety, you may
request in writing an alternate communication method and/or location.
Important: EYECONIC may require that a request contain a statement that disclosure of all or part of the information to which
the request pertains could endanger the individual, and EYECONIC may, if and to the extent that applicable law allows, request payment for this service.
Examples: The patient may decide, for his or her safety, to have correspondence containing his or her Protected Health
Information sent somewhere other than to his or her home, or to have the information sent via fax rather than mailed.
Accounting of Disclosures
If a disclosure of your Protected Health Information was made for a reason other than treatment, payment or health care
operations, you have a right to receive an accounting of the disclosure.
Important: If the disclosure was made to you, EYECONIC will not provide an accounting.
Receive a Copy Complaints
You can view and print a copy of this Notice of Privacy Practices through Eyeconic.com.
If you believe that your privacy rights have been violated, you may submit a complaint to EYECONIC or to the U.S. Secretary
of Health and Human Services at any time. EYECONIC will not retaliate against you for filing a complaint. You may file a
complaint with EYECONIC at Eyeconic.com.
For questions about this notice or your privacy, contact us at 1-855-EYECONIC (1-855-393-2664) or firstname.lastname@example.org
Our hours are Monday to Friday, 7:00 a.m. to 5:00 p.m. PT.