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Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices State and School Employees’ Health Insurance Plan

This Notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Please review this Notice carefully.

This Notice relates to the State and School Employees’ Health Insurance Plan only. This Notice does not apply to other covered programs offered by your employer, such as dental, vision, and flexible spending accounts. This Notice does not apply to non-covered programs such as life insurance and workers’ compensation.

This Notice describes how the State and School Employees’ Health Insurance Plan may

use and disclose Protected regarding this information.

Health Information (PHI) and also explains your Protected Health Information is individually

legal rights identifiable

information provided to

about your past, present, or future health you, or the payment for health services.

or

condition,

health

care

services

This Notice is effective on April 14, 2003.

The State and School Employees’ Health Insurance Plan (Plan) is required by law to maintain the privacy of your PHI and to provide you with this Notice of the Plan’s legal

duties and

privacy

described

in this

practices. Notice.

The Plan is required to follow the privacy practices This Notice is posted on the Plan’s website at

knowyourbenefits.dfa.state.ms.us. The practices and the terms of this Notice at revised Notice will be mailed to those

Plan reserves the right to change its privacy any time. If a change is made to this Notice, a individuals defined as “enrollees” in the Plan

Document. The revised Notice will be to receive a paper copy of this Notice the Plan’s HIPAA Notice of Privacy

posted on the Plan’s website. You have the right upon request. You may request a paper copy of by contacting the Department of Finance and

Administration, Office of Insurance, in the Jackson area at 601-359-3411, 586-2781, or by writing to P.O. Box 24208, Jackson, MS 39225-4208.

toll-free

at

866-

PERMITTED USES AND DISCLOSURES The examples of permitted uses and disclosures listed below are not provided as an all- inclusive list of the situations in which PHI may be used and disclosed by the Plan. However, the Plan will only use or disclose your PHI, without your written authorization, in situations falling into one of these categories.

Uses And Disclosures For Purposes Of Treatment, Payment, or Health Care Operations

1

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