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.
"Enrollment System" means the electronic system owned and operated by Benelogic LLC ("Benelogic") that allows You to view information regarding Your employer's Plan and may also allow You to enroll, administer and manage Your and Your eligible dependents' employee group benefits and Your individual supplemental insurance.
"Personal Information" means all personally identifiable information referring or relating to an individual, including but not limited to such individual's name, addresses, telephone numbers, social security number, employment information and protected health information, as such term is defined in the Health Insurance Portability and Accountability Act, as amended ("HIPAA").
"Plan" shall mean Your employer's employee health care/benefits plan and/or flexible spending accounts plan, or portions of such plan(s) with respect to which the Enrollment System is used.
"You" or "Your" means the individual (or the personal representative of such individual) who accesses the Enrollment System and/or uses the Enrollment System to apply to enroll in his/her employer's Plan and/or complete an application for individual insurance to supplement his/her employer's Plan.
III Confidentiality and Security
Benelogic acknowledges that You have a right of privacy in all Personal Information that refers or relates to You. Benelogic shall maintain the security of Personal Information, and protect the integrity of Personal Information, with a commercially reasonable degree of care. Please remember that the security measures Benelogic takes are not foolproof; no website can guarantee that Personal Information will be protected in all situations. Therefore Benelogic can only state that it will make a reasonable effort to protect all Personal Information that You provide from unauthorized access and it will hold all Personal Information in confidence in accordance with this Policy for so long as Benelogic maintains such Personal Information. Benelogic does not sell, license or rent any Personal Information about You and/or Your dependents to any third party without Your consent.
IV Uses and Disclosures of Personal Information
Benelogic shall not use or disclose Personal Information except:
As specifically required or permitted by applicable law or regulation, or for law enforcement purposes;
To the extent required or permitted by subpoena, court order, or other judicial or administrative proceedings, including workers' compensation programs;
As expressly permitted in writing by You;
Solely as necessary to effect, administer, service, process or enforce a transaction, product or service You requested or authorized, such as disclosing Personal Information to a supplemental insurance carrier in response to Your submission of an application to purchase individual supplemental insurance through the Enrollment System;
As permitted under the agreement between Benelogic and Your employer relating to Your access and use of the Enrollment System, such as disclosing Personal Information to Your employer, the Plan sponsor (if not Your employer), the Plan or Your employer's insurance broker to inform them that You have applied to be enrolled in the Plan; and
Otherwise solely to operate and provide the services associated with the Enrollment System, such as disclosing Personal Information to the insurance carrier for the Plan to determine Your eligibility for inclusion in the Plan.
V. Representations and Warranties
VI. Your Rights
Right to Communicate By Other Means. Benelogic will accommodate Your reasonable requests to receive and send Personal Information by alternative means or at or to alternative locations. However, Benelogic reserves the right to charge reasonable costs for complying with such requests and to reserve its compliance with such requests until receipt of payment for such costs.
Right to File a Complaint. If You believe that Your privacy rights have been violated, You may complain to Benelogic at the address set forth below. Additionally to the extent that Your complaint relates to PHI in Benelogic's possession, custody or control, you may file a complaint with the Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue S.W., Washington, DC 20201. Benelogic will take no action against You for filing a complaint with the Department of Health and Human Services.
Right to Inspect and Copy Personal Information. For so long as Benelogic maintains Personal Information that refers or relates to You and/or Your dependents, You have a right to inspect and obtain a copy of all such Personal Information. If the Enrollment System allows You such access rights, You may inspect Personal Information that refers or relates to You and/or Your dependents on-line via the Enrollment System and print out onto paper the information displayed thereon. If You wish to obtain copies by mail, Benelogic may take up to sixty (60) days to provide the requested copies. Your written request must clearly identify all records that You wish to obtain and provide Your address for mailing. You will be invoiced for all reasonable, related costs (e.g., copying and mailing), and, upon receipt of Your payment, Benelogic will mail to the address listed in Your request all documents clearly identified in Your request that You are authorized to obtain.
Right to Request Amendment of Personal Information You also have the right to request Benelogic amend Personal Information that refers or relates to You and/or Your dependents if You discover any inaccuracies or incomplete information on the Enrollment System. If such Personal Information consists of PHI, Benelogic has up to ninety (90) days to act on Your request. If Benelogic denies the request in whole or in part, it will provide You the reasons for such denial in writing.
Right to Receive an Accounting Promptly upon receipt of Your written request, Benelogic will provide You with an accounting of disclosures by Benelogic of all PHI that refers or relates to You and/or Your dependents (to the extent that Benelogic has or had possession, custody or control of such PHI) during the six (6) years prior to the date of Your request. However, such accounting need not include disclosures of such PHI made: (i) to carry out treatment, payment or health care operations; (ii) to You; or (iii) prior to the HIPAA compliance date. You will be invoiced for all reasonable, related costs (e.g., copying and mailing) incurred by Benelogic to produce such accounting, and, upon receipt of Your payment, Benelogic will mail the accounting to the address listed in Your request.
Right to Request Restrictions on Use and Disclosure. You may request in writing that Benelogic restrict its use and disclosures of PHI that refers or relates to You and/or Your dependents (to the extent that Benelogic has or had possession, custody or control of such PHI). Such request may include limiting use and disclosure of PHI to carry out treatment, payment and health care operations, or to restrict disclosures to family members. However, Benelogic is not required to agree to Your request.
VII. Personal Information After Termination
IX. Effect of Termination
X. Other Information Collected
XI. Extent of Obligation
XII. Policy Applicability
This Policy does not apply to information that has been de-identified. De-identified information is not Personal Information, but rather is information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual.
XIII. Plan Enrollment and Consent
XIV. Supplemental Insurance Application and Consent
XV. Children's Policy (Age 12 and Under)
Benelogic takes children's privacy seriously. Benelogic does not seek to collect Personal Information from children through the Enrollment System. Benelogic collect Personal Information referring or relating to a child, but only to the extent that You provide such information for the purpose of obtaining coverage for Your child as a dependent under Your employer's Plan. If Benelogic becomes aware that a person submitting Personal Information through any part of the Enrollment System is a child, Benelogic promptly deletes the information does not use it for any purpose, nor does Benelogic disclose it to third parties. Since Benelogic does not seek to collect any Personal Information from children, if a parent requests to review information submitted by their child before Benelogic has discovered and deleted the information, Benelogic will honor that request.
XVI. Change of Policy
XVII. Questions and More Information
If You have any questions regarding this Policy or the matters addressed in it, You may contact Your employer or Benelogic may be reached care of: Compliance Director, Benelogic, LLC, 9475 Deereco Rd. Suite 310, Timonium, MD 21093, 443-322-2494 (phone), 443-322-2496 (fax), email@example.com (email).