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YOUR POLICY

Your privacy is important to us. We respect and protect your privacy. Molina uses and shares your information to provide you with health benefits. We want to let you know how your information is used or shared.

Your Protected Health Information

PHI means protected health information. PHI is health information that includes your name, member number or other identifiers, and is used or shared by Molina.

Why does Molina use or share our Members’ PHI?

  • To provide for your treatment
  • To pay for your health care
  • To review the quality of the care you get
  • To tell you about your choices for care
  • To run our health plan
  • To use or share PHI for other purposes as required or permitted by law.

When does Molina need your written authorization (approval) to use or share your PHI?

Molina needs your written approval to use or share your PHI for purposes not listed above.

What are your privacy rights?

  • To look at your PHI
  • To get a copy of your PHI
  • To amend your PHI
  • To ask us to not use or share your PHI in certain ways
  • To get a list of certain people or places we have given your PHI

How does Molina protect your PHI?

Molina uses many ways to protect PHI across our health plan. This includes PHI in written word, spoken word, or in a computer. Below are some ways Molina protects PHI:

  • Molina has policies and rules to protect PHI.
  • Molina limits who may see PHI. Only Molina staff with a need to know PHI may use it.
  • Molina staff is trained on how to protect and secure PHI.
  • Molina staff must agree in writing to follow the rules and policies that protect and secure PHI
  • Molina secures PHI in our computers. PHI in our computers is kept private by using firewalls and passwords.

What must Molina do by law?

  • Keep your PHI private.
  • Give you written information, such as this on our duties and privacy practices about your PHI.
  • Follow the terms of our Notice of Privacy Practices.

What can you do if you feel your privacy rights have not been protected?

  • Call or write Molina and complain.
  • Complain to the Department of Health and Human Services.

We will not hold anything against you. Your action would not change your care in any way.

The above is only a summary. Our Notice of Privacy Practices has more information about how we use and share our Members’ PHI. Our Notice of Privacy Practices is in the following section of this document. It is on our web site at www.molinahealthcare.com. You may also get a copy of our Notice of Privacy Practices by calling our Member Services Department at 1 (877) 335-3305.

NOTICE OF PRIVACY PRACTICES

MOLINA HEALTHCARE OF PUERTO RICO, INC.

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.

Molina Healthcare of Puerto Rico, Inc. ("Molina Healthcare", "Molina", "we" or "our") uses and shares protected health information about you to provide your health benefits. We use and share your information to carry out treatment, payment and health care operations. We also use and share your information for other reasons as allowed and required by law. We have the duty to keep your health information private and to follow the terms of this Notice. The effective date of this Notice is March 1, 2015.

PHI stands for these words, protected health information. PHI means health information that includes your name, Member number or other identifiers, and is used or shared by Molina.

Why does Molina use or share your PHI?

We use or share your PHI to provide you with healthcare benefits. Your PHI is used or shared for treatment, payment, and health care operations.

For Treatment

Molina may use or share your PHI to give you, or arrange for, your medical care. This treatment also includes referrals between your doctors or other health care providers. For example, we may share information about your health condition with a specialist. This helps the specialist talk about your treatment with your doctor.

For Payment

Molina may use or share PHI to make decisions on payment. This may include claims, approvals for treatment, and decisions about medical need. Your name, your condition, your treatment, and supplies given may be written on the bill. For example, we may let a doctor know that you have our benefits. We would also tell the doctor the amount of the bill that we would pay.

For Health Care Operations

Molina may use or share PHI about you to run our health plan. For example, we may use information from your claim to let you know about a health program that could help you. We may also use or share your PHI to solve Member concerns. Your PHI may also be used to see that claims are paid right.

Health care operations involve many daily business needs. It includes but is not limited to, the following:

  • Improving quality;
  • Actions in health programs to help Members with certain conditions (such as asthma);
  • Conducting or arranging for medical review;
  • Legal services, including fraud and abuse detection and prosecution programs;
  • Actions to help us obey laws;
  • Address Member needs, including solving complaints and grievances.

We will share your PHI with other companies ("business associates") that perform different kinds of activities for our health plan. We may also use your PHI to give you reminders about your appointments. We may use your PHI to give you information about other treatment, or other health-related benefits and services.

When can Molina use or share your PHI without getting written authorization (approval) from you?

The law allows or requires Molina to use and share your PHI for several other purposes including the following:

Required by law

We will use or share information about you as required by law. We will share your PHI when required by the Secretary of the Department of Health and Human Services (HHS). This may be for a court case, other legal review, or when required for law enforcement purposes.

Public Health

Your PHI may be used or shared for public health activities. This may include helping public health agencies to prevent or control disease.

Health Care Oversight

Your PHI may be used or shared with government agencies. They may need your PHI for audits.

Research

Your PHI may be used or shared for research in certain cases.

Legal or Administrative Proceedings

Your PHI may be used or shared for legal proceedings, such as in response to a court order.

Law Enforcement

Your PHI may be used or shared with police to help find a suspect, witness or missing person.

Health and Safety

Your PHI may be shared to prevent a serious threat to public health or safety.

Government Functions

Your PHI may be shared with the government for special functions. An example would be to protect the President.

Victims of Abuse, Neglect or Domestic Violence

Your PHI may be shared with legal authorities if we believe that a person is a victim of abuse or neglect.

Workers Compensation

Your PHI may be used or shared to obey Workers Compensation laws.

Other Disclosures

Your PHI may be shared with funeral directors or coroners to help them to do their jobs.

When does Molina need your written authorization (approval) to use or share your PHI?

Molina needs your written approval to use or share your PHI for a purpose other than those listed in this Notice. Molina needs your authorization before we disclose your PHI for the following: (1) most uses and disclosures of psychotherapy notes; (2) uses and disclosures for marketing purposes; and (3) uses and disclosures that involve the sale of PHI. You may cancel a written approval that you have given us. Your cancellation will not apply to actions already taken by us because of the approval you already gave to us.

What are your health information rights?

You have the right to:

  • Request Restrictions on PHI Uses or Disclosures (Sharing of Your PHI)

    You may ask us not to share your PHI to carry out treatment, payment or health care operations. You may also ask us not to share your PHI with family, friends or other persons you name who are involved in your health care. However, we are not required to agree to your request. You will need to make your request in writing. You may use Molina’s form to make your request.

  • Request Confidential Communications of PHI

    You may ask Molina to give you your PHI in a certain way or at a certain place to help keep your PHI private. We will follow reasonable requests, if you tell us how sharing all or a part of that PHI could put your life at risk. You will need to make your request in writing. You may use Molina’s form to make your request.

  • Review and Copy Your PHI

    You have a right to review and get a copy of your PHI held by us. This may include records used in making coverage, claims and other decisions as a Molina Member. You will need to make your request in writing. You may use Molina’s form to make your request. We may charge you a reasonable fee for copying and mailing the records. In certain cases we may deny the request. Important Note: We do not have complete copies of your medical records. If you want to look at, get a copy of, or change your medical records, please contact your doctor or clinic.

  • Amend Your PHI

    You may ask that we amend (change) your PHI. This involves only those records kept by us about you as a Member. You will need to make your request in writing. You may use Molina’s form to make your request. You may file a letter disagreeing with us if we deny the request.

  • Receive an Accounting of PHI Disclosures (Sharing of Your PHI)

    You may ask that we give you a list of certain parties that we shared your PHI with during the six years prior to the date of your request. The list will not include PHI shared as follows:

    • for treatment, payment or health care operations;
    • to persons about their own PHI;
    • sharing done with your authorization;
    • incident to a use or disclosure otherwise permitted or required under applicable law;
    • PHI released in the interest of national security or for intelligence purposes; or
    • as part of a limited data set in accordance with applicable law.

We will charge a reasonable fee for each list if you ask for this list more than once in a 12- month period. You will need to make your request in writing. You may use Molina’s form to make your request.

You may make any of the requests listed above, or may get a paper copy of this Notice. Please call our Member Services Contact Center at 1 (877) 335-3305.

What can you do if your rights have not been protected?

You may complain to Molina and to the Department of Health and Human Services if you believe your privacy rights have been violated. We will not do anything against you for filing a complaint. Your care and benefits will not change in any way.

You may complain to us at:

Molina Healthcare of Puerto Rico, Inc.

654 Plaza, Suite 1600

654 Avenida Munoz Rivera

San Juan, Puerto Rico 00918

1(877) 335-3305

You may file a complaint with the Secretary of the U.S. Department of Health and Human Services at:

Office for Civil Rights

U.S. Department of Health & Human Services

Jacob Javits Federal Building

26 Federal Plaza - Suite 3312

New York, NY 10278

Phone (800) 368-1019; FAX (212) 264-3039; TDD (800) 537-7697

What are the duties of Molina?

Molina is required to:

  • Keep your PHI private;
  • Give you written information such as this on our duties and privacy practices about your PHI;
  • Provide you with a notice in the event of any breach of your unsecured PHI;
  • Not use or disclose your genetic information for underwriting purposes;
  • Follow the terms of this Notice.

 

This Notice is Subject to Change

Molina reserves the right to change its information practices and terms of this Notice at any time. If we do, the new terms and practices will then apply to all PHI we keep. If we make any material changes, Molina will post the revised Notice on our web site and send the revised Notice, or information about the material change and how to obtain the revised Notice, in our next annual mailing to our members then covered by Molina.

Contact Information

If you have any questions, please contact the following office:

Molina Healthcare of Puerto Rico, Inc.

Attention: Manager of Member Services

654 Plaza, Suite 1600

654 Avenida Munoz Rivera

San Juan, Puerto Rico 00918

1(877) 335-3305

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