Policies & Practices
Table of Contents
Notice of Privacy Practices
This Notice of Privacy Practices is for members who receive services from Capital Health Plan facilities and providers located at Metropolitan Boulevard, Centerville Place, or Governor’s Square Boulevard. The practices described in this notice also apply to all health information received by Capital Health Plan at any of our business locations from independent healthcare providers, insurers, or other entities that may send us information. Capital Health Plan is required to maintain the privacy of your health information at our facilities and:
- Provide you with this notice
- Abide by the terms of this notice
- Notify you if we are unable to agree to a requested restriction
- Accommodate reasonable requests you may have to communicate by alternative means or locations
- Prohibit the use or disclosure of genetic information for life insurance purposes
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.
Download a copy of the Notice of Privacy Practices.
If you receive care from a physician or other healthcare provider that is not located within Capital Health Plan, you should contact the provider’s office directly to obtain specific information about their Notice of Privacy Practices.
Your Rights
You have the right to get:
- A copy of your paper or electronic medical record
- Correct your paper or electronic medical record
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we’ve shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
Your Choices
You have choices available regarding the way that we use and share information as we:
- Tell family and friends about your condition
- Provide disaster relief
- Provide mental health care
- Market our services
Our Uses & Disclosures
We may use and share your information as we:
- Treat you
- Run our organization
- Bill for your services
- Pay for your health services
- Help with public health and safety issues
- Do research
- Comply with the law
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal action
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an Electronic or Paper Copy of Your Medical & Claims Record
- You can ask to see or get an electronic copy or paper copy of your medical and claims record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health and claims information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask Us to Correct Your Medical Record
- You can ask us to correct health information about you that you think is incorrect or incomplete.
- Ask us how to do this – We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request Confidential Communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
Ask Us to Limit What We Use or Share
- You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a List of Those With Whom We’ve Shared Information
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free, but we’ll charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a Copy of This Privacy Notice
You can ask for a paper copy of this notice at any time. We will provide you with a paper copy promptly.
Choose Someone to Act for You
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a Complaint If You Feel Your Rights Are Violated
You can complain if you feel we have violated your rights by contacting Capital Health Plan Member Services at (850) 383-3311 or 1 (877) 247-6512, 8:00 a.m. to 5:00 p.m., Monday – Friday.
Our TTY/TTD team (for the hearing impaired) can be contacted at (850) 383-3534 or 1 (877) 870-8943.
Our Medicare Member Services team can be contacted at (850) 523-7441 or 1 (877) 247-6512 8:00 a.m. – 8:00 p.m., seven days a week, starting October 1 – March 31 and 8:00 a.m. – 8:00 p.m., Monday – Friday, April 1 – September 30.
Our State of Florida Member Services team can be contacted at call 1-877-392-1532, 7:00 a.m. – 7:00 p.m.
You can also fax us at (850) 523-7419 or send our team an email at [email protected].
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visitingg HIPAA What to Expect.
- We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care.
- Share information in a disaster relief situation.
- If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
- Most sharing of psychotherapy notes
Our Uses & Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
- Treat you
We can use your health information and share it with other professionals who are treating you.Example: A doctor treating you for an injury asks another doctor about your overall health condition. Example: A doctor sends us information about your diagnosis and treatment plan so we can arrange additional services.
- Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.Example: We use health information about you to manage your treatment and services.
- Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.Example: We give information about you to pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/
- To help with public health and safety issues as we can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
- To comply with the law as we will share information about you if state or federal laws require it, including with the Department of Health and Human Services if they want to see that we’re complying with federal privacy law.
- To respond to organ and tissue donation requests as we can share health information about you with organ procurement organizations.
- To work with a medical examiner or funeral director as we can share health information with a coroner, medical examiner, or funeral director when an individual dies.
- To address workers’ compensation, law enforcement, and other government requests as we can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
- To respond to lawsuits and legal actions as we can share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
Effective Date: November 14, 2023
Contact Us
You can contact Capital Health Plan Member Services team at (850) 383-3311, or 1 (877)247-6512 8:00 a.m. to 5:00 p.m., Monday – Friday.
Our Medicare Member Services team can be contacted at (850) 523-7441 or 1 (877) 247-6512, 8:00 a.m. – 8:00 p.m., seven days a week, starting October 1 through March 31 and 8:00 a.m. – 8:00 p.m., Monday – Friday, starting April 1 through September 30.
Our TTY/TTD team (for the hearing impaired) can be contacted at (850) 383-3534 or 1 (877) 870-8943, 8:00 a.m. to 5:00 p.m., Monday – Friday.
Our State of Florida Member Services team can be contacted at 1 (877) 392-1532, 7:00 a.m. – 7:00 p.m. Monday – Friday.
You can also fax us at (850) 523-7419 or send our team an email at [email protected].
Additional copies of this notice are available upon request and posted on the Capital Health Plan website.
Website Privacy Policy
Your privacy is very important to Capital Health Plan. The purpose of this policy is to inform you of the information that may be collected and used by navigating our website. By using our website, you consent to the practices set forth in this policy and the processing of your information where applicable. (ie. Enrolling in/Purchasing healthcare coverage, etc.) Please note that while providing requested information is voluntary, failing to provide the necessary information may delay or prevent your ability to obtain coverage.
This policy is separate from our Notice of Privacy Practices and specific to our website. We reserve the right to update or modify this Website Privacy Policy at any time. If we make changes, they will be noted on this page so that you may continue to be informed with regard to what information may be collected and used as well as how it is protected. Please review the information carefully.
Information Collected
CHP may collect non-personal information such as a user’s domain name or IP Address along with the type of browser or the type of device (ie. Mobile etc.) used to access our site. None of this information will reveal anything personal about the user.
Personal information such as name, age, date of birth, gender, email, etc. may be requested for the purposes of providing product information or to facilitate the enrollment and purchase of insurance. As stated above, this is strictly voluntary and you are under no obligation to provide any of this information. However, certain information may be required in order to provide you with product information or facilitate enrollment. Failing to provide the necessary information may delay or prevent your ability to obtain coverage.
Information Use
Non-personal information such as domain names and IP addresses are not stored by CHP. Google Analytics is used to analyze the traffic visiting our site. For more information regarding Google Analytics please visit Google’s site. Single session cookies are used to provide a user with a better website experience and their use, simply tells the server that all of a person’s requests within a certain period of time came from the same computer and should be treated as a single session. Any personal information provided by you is used solely for the purposes of providing you with insurance information or facilitating your enrollment into one of our products.
Information Shared
Non-personal information such as domain names and IP addresses are not stored by CHP. Google Analytics is used to analyze the traffic visiting our site. For more information regarding Google Analytics please visit Google’s site. Single session cookies are used to provide a user with a better website experience and their use, simply tells the server that all of a person’s requests within a certain period of time came from the same computer and should be treated as a single session. These are temporary files which are erased when you close your browser. Any personal information provided by you is used solely for the purposes of providing you with insurance information or facilitating your enrollment into one of our products.
Security
CHP adheres to the generally accepted industry standard with regard to the safeguarding of information. All traffic to CHP’s site is encrypted using SSL protocol as well as for those sections in which personal information is being requested. You can verify by looking for the closed lock icon in your browser or by looking for the https at the beginning of the web page address.
Contact Us
Our Member Services team can be contacted at (850) 383-3311, 8:00 a.m. to 5:00 p.m., Monday – Friday.
Our Medicare Member Services team can be contacted at (850) 523-7441, 8:00 a.m. – 8:00 p.m., seven days a week, starting October 1 through March 31 and 8:00 a.m. – 8:00 p.m., Monday – Friday, starting April 1 through September 30.
Our TTY/TTD team (for the hearing impaired) can be contacted at (850) 383-3534 or 1-877-870-8943, 8:00 a.m. to 5:00 p.m., Monday – Friday.
Our State of Florida Member Services team can be contacted at 1 (877) 392-1532, 7:00 a.m. – 7:00 p.m. Monday – Friday.
You can also fax us at (850) 523-7419 or send our team an email at [email protected].
Medicare Member Privacy Policy
Capital Health Plan knows that the way we conduct our business offers us the opportunity to earn your respect and trust. Our members are our reason for being. To that end, we believe CHP members have the right to privacy and that their nonpublic personal, financial, and health information should be kept confidential. Our practices to protect your privacy are not new. However, laws now require that we notify you annually about our privacy policy concerning:
- What kind of personal information we collect about you and how we obtain it
- How we use your personal information
- What kind of personal information about you we release to other companies
- How we protect your personal information
This Privacy Notice is provided to help you better understand how we protect your nonpublic personal, financial, and health information. If you have questions about our privacy policy, please feel free to contact us.
- Members call CHP Member Services at (850) 518-6679 or (877) 247-6512
- Medicare Members call 850) 523-7441 or 1 (877) 247-6512, 8:00 a.m. – 8:00 p.m., seven days a week, October 1 – March 31; 8:00 a.m. – 8:00 p.m., Monday – Friday, April 1 – September 30
- Hearing Impaired or TTY users should call (850) 383-3534 or (877) 870-8943), 8:00 a.m. to 8:00 p.m.; seven days a week, October 1 to February 14; 8:00 a.m. to 8:00 p.m., Monday to Friday, February 15 to September 30.
- State of Florida CHP Members can call (877) 392-1532, 7:00 am to 7:00 p.m.
- Employer representatives can call the Marketing Office at (850) 523-7333.
What kind of personal information do we collect and how do we obtain it?
Generally, the information includes your name, address, phone number, social security number, date of birth, age, sex, height and weight, occupation, health habits, and general medical information. It could also include accident and injury dates. Most of this information is provided by you. We obtain personal information about you from the following sources:
- An application for a health plan
- Your physician or other health practitioner
- Your employer
- Other sources
How do we use your personal information?
We use your personal information to perform transactions and functions necessary to implement and administer the health plan benefits purchased from us. On occasion, your personal information is used for reporting or other functions required or permitted by law.
What kind of personal information about you do we release?
We may share any of the information we collect about you (as described above) with our affiliates, namely our health business partners. We may disclose any of the information we collect about you to other parties, including vendors and governmental agencies retained to audit medical records and billings. However, the type and the amount of information we share with others is limited to what is necessary to implement and administer the health plan you have with us, or as otherwise permitted or required by law. We may disclose any of the information we collect about you (as described above) to companies that perform other services on our behalf, including administrative services.
How do we protect your information?
We maintain physical, electronic, and procedural safeguards to protect your personal information. We access and use your personal information to the extent necessary to administer the health plan services you are entitled to. We establish confidentiality agreements with contracted parties that receive nonpublic personal, financial, and health information about you. We restrict access to your nonpublic personal, financial, and health information to those employees who need to know that information to administer the product or service you purchased from us.
Capital Health Plan Silver Advantage (HMO), Advantage Plus (HMO), Preferred Advantage (HMO), and Retiree Advantage (HMO) are HMO plans with a Medicare contract. Enrollment in Capital Health Plan Silver Advantage, Advantage Plus, Preferred Advantage, and Retiree Advantage depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
If you have questions, please call Member Services at (850) 523-7441 or 1 (877) 247-6512 8:00 a.m. – 8:00 p.m., seven days a week, October 1 – March 31; 8:00 a.m. – 8:00 p.m., Monday – Friday, April 1 – September 30. State of Florida members call 1 (877) 392-1532, 7:00 a.m. – 7:00 p.m. TTY/TTD (850) 383-3534 or 1 (877) 870-8943.