This Notice describes how dental information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
For purposes of this Notice, "Family & Cosmetic Dentistry" and the pronouns "we," "us" and "our" refer to Group Dental Service, Inc. and its subsidiary, Group Dental Service of Family & Cosmetic Dentistry, Inc. The entities have been designated as a single affiliated covered entity for federal privacy purposes.
Family & Cosmetic Dentistry considers personal information to be confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as our own company privacy policies. Our practices apply to current and former members.
How Family & Cosmetic Dentistry Collects Personal Information. We collect a variety of personal information to administer your dental coverage. Some of this information is provided by members in enrollment forms, correspondence and dental claims (such as your name, address, social security number, birth date and dependent information). We also receive personal information (such as eligibility and claims information) through transactions with our affiliates and members, employers, other insurers and dental care providers. We retain this information after your coverage ends. We limit the collection of personal information to that which is necessary to administer our business, provide quality service and meet regulatory requirements.
How We Protect Personal Information. We treat personal information securely and confidentially. We limit access to personal information to only those persons who need to know that information to provide our products or services to members (for example, our claims processors); these persons are trained on the importance of safeguarding this information and must comply with our procedures and applicable law. We meet strict physical, electronic and procedural security standards to protect personal information and maintain internal procedures to promote the integrity and accuracy of that information.
How Family & Cosmetic Dentistry Uses and Discloses Personal Information. In order to provide your dental coverage, we need to collect personal information about you. We obtain that information from many sources, including your employer or your Fund office, other insurers, third party administrators (TPAs) and dental providers.
We may use and disclose personal information about you for the following reasons:
Health Care Operations. In order to run our dental care business we may use and disclose your personal information for operational activities such as quality assessment and improvement; licensing; accreditation, performance measurement and outcomes assessment; and preventive health. For example, we may use the information to determine how many dentists performed root canals in your geographic area. Other operational uses and disclosures include underwriting and rating; fraud detection; issuing policy and certificates of coverage and other general administration, including data and information systems management and customer service.
Payment. In order to process and pay for your dental services, we may use and disclose your personal information in various ways, including utilization review and pre-determination of benefits, coordinating care, determining eligibility, collecting premiums, calculating co-payments and responding to complaints, appeals and requests for external review. For example, we may use your dental history to determine if a crown is necessary or appropriate and during the process, we may disclose information to your provider. We also mail an explanation of your benefits to the address we have on record for the member.
Treatment. We may disclose information to dentists and other health care providers who take care of you. For example, we may disclose information about you to a specialist when you are referred by a general dentist for treatment.
Disclosures to Other Covered Entities. We may disclose personal information to other covered entities, or to business associates of those entities, for treatment, payment and certain health care operations purposes. For example, we may disclose your personal information to other health plans maintained by your employer or Fund if it has been arranged for us to do so in order to have certain expenses reimbursed.
Additional Reasons for Disclosure
We may also use or disclose dental information about you to provide you with treatment alternative or other dental-related benefits and services. We may also disclose your information in support of:
Plan Administration - to your employer or Fund, when we have been informed that appropriate language has been included in your plan documents, or when summary data is disclosed to assist in rating or amending a group dental plan.
Business Associates - to persons who provide services to us and assure us they will protect the information in a manner that we protect the information.
Industry Regulation - to state insurance departments, state-managed Care departments, dental Boards, U.S. Food and Drug Administration, U.S. Department of Labor and other government agencies that regulate us.
Law Enforcement - to federal, state and local law enforcement officials
Legal Proceedings - in response to a court order or other lawful process.
Public Welfare - to address matters of public interest as required or permitted by law (e.g., child abuse or neglect, threats to public health and safety and national security).
Disclosures to Others Involved in Your Dental Care. We may also disclose your dental Information to a relative, a friend, the participant of your dental plan or any other person you identify, provided the information is directly relevant to that person's involvement with your dental care or payment for that care. For example, if a family member calls us with prior knowledge of a dental claim, we may confirm whether or not the claim has been received and paid. You have the right to stop or limit this kind of disclosure by calling the toll-free Member Services number in your Certificate of Coverage.
If you are a minor, you also may have the right to block parental access to your dental information in certain circumstances, if permitted by state law. You can contact us using the toll-free Member Services number - or you may have your provider contact us.
Uses and Disclosures Requiring Your Written Authorization. In all situations other than those described above, we will ask for your written authorization before using or disclosing personal information about you. If you have given us an authorization, you may revoke it at any time, if we have not already acted on it. If you have questions regarding authorizations, please call the toll-free Member Services number in your Certificate of Coverage.
Your Legal RightsThe federal privacy regulations give you the right to make certain requests regarding your dental health information. You may ask us to:
Communicate with you in a certain way or at a certain location. For example, if you are an adult, you may ask us to send your dental claims to a different address than that of the participant, we will accommodate reasonable requests.
Restrict the way we use or disclose your dental information in connection with health care operations, payment and treatment. We will consider, but may not agree to, such requests, you also have the right to ask us to restrict disclosures to persons involved in your dental care.
Inspect and obtain a copy of dental information that is contained in a designated record set, which includes the dental or other records maintained and used in making enrollment, payment, claims adjudication, dental management and other decisions. We may ask you to make your request in writing, may charge a reasonable fee for producing and mailing the copies and, in certain cases, may deny the request.
Amend dental information in the designated record set. Your request must be in writing and must include the reason for the request. If we deny the request, you may file a written statement of disagreement.
Provide a list of certain disclosures we have made about you, such as disclosures of dental information to government agencies that license us. Your request must be in writing. If you request such an accounting more than once in a 12-month period, we may charge a reasonable fee.
Obtain a paper copy of this notice by contacting us at the number in your Certificate of Coverage.
ComplaintsYou also have the right to file a complaint if you think your privacy rights have been violated. To do so, you may write or call Family & Cosmetic Dentistry, and direct your complaint to the HIPAA Complaint Contact Person. You may also write to the secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
How to Contact UsYou can contact us using the toll-free Member Services number in your Certificate of Coverage, or you can write to:
Privacy Officer at Group Dental Service Family & Cosmetic Dentistry, Inc. 111 dental waySuite 000Dentistville, California 000000.
Family & Cosmetic Dentistry's Legal ObligationsThe federal privacy regulations require us to keep personal information about you private, to give you notice of our legal duties and privacy practices and to follow the terms of the notice currently in effect.
Notice Subject to ChangeWe may change the terms of this notice and our privacy policies at any time. If we do, the new terms and policies will be effective for all of the information that we already have about you, as well as any information that we may receive or hold in the future-.We will send a revised Notice to all current participants within 60 days of any material change to the Notice. In addition, we will notify all current participants at least once every three years of the availability of the notice and how to obtain the Notice.
Personal InformationFamily & Cosmetic Dentistry does not collect personal information about you on its Web site(s) unless you voluntarily provide such information. By personal information, we mean information that identifies you as an individual, such as your name, address or email address.
In cases where we do collect personal information that you voluntarily provide, we will not sell, share, trade, rent, distribute or otherwise disclose that information unless expressly authorized by you, or unless it is necessary for our contractors to perform certain functions, or as required or permitted by law. In any such instance, the recipient of that information will be required to protect the information and use it only for the purpose for which it was provided.
EmailTo protect your privacy, please do not correspond with Family & Cosmetic Dentistry via email if you consider the content of those communications to be confidential. Non-encrypted email communications can be viewed while in transit.
CookiesLike most commercial Web sites, Family & Cosmetic Dentistry may use "cookies" - a small piece of data that is stored on an end user's hard drive. It is not personally identifiable to you, and has no ability to read other information on your computer. Its purpose is to enhance site visitors' experience by recognizing repeat users and better serving those users when they return to the site. Most Internet browsers can easily be configured to notify you when a Web site is preparing to send a cookie, providing the option to refuse that piece of data.
Data SecurityFamily & Cosmetic Dentistry adheres to strict standards to protect non-public information at Family & Cosmetic Dentistry Web sites against unauthorized access. Those safeguards are physical, administrative and technical. We require unique usernames and passwords that must be entered each time a plan member or employer logs on to maintain data integrity, prevent unauthorized access, and ensure appropriate use.
Tracking Other Information Family & Cosmetic Dentistry and its contractors may track traffic on Family & Cosmetic Dentistry Web site(s) through information such as number of visitors on the site and on certain pages. That data is aggregate only, and does not identify you personally. We use that information to improve the usefulness of the site.
Change to this PolicyThis policy may change from time to time, without notice. It is not intended to create any contractual or other legal rights or obligations on behalf of any party.
For purposes of this Notice, "Family & Cosmetic Dentistry" and the pronouns "we," "us" and "our" refer to Group Dental Service, Inc. and its subsidiary, Group Dental Service of Family & Cosmetic Dentistry, Inc. The entities have been designated as a single affiliated covered entity for federal privacy purposes.
Family & Cosmetic Dentistry considers personal information to be confidential. We protect the privacy of that information in accordance with federal and state privacy laws, as well as our own company privacy policies. Our practices apply to current and former members.
How Family & Cosmetic Dentistry Collects Personal Information. We collect a variety of personal information to administer your dental coverage. Some of this information is provided by members in enrollment forms, correspondence and dental claims (such as your name, address, social security number, birth date and dependent information). We also receive personal information (such as eligibility and claims information) through transactions with our affiliates and members, employers, other insurers and dental care providers. We retain this information after your coverage ends. We limit the collection of personal information to that which is necessary to administer our business, provide quality service and meet regulatory requirements.
How We Protect Personal Information. We treat personal information securely and confidentially. We limit access to personal information to only those persons who need to know that information to provide our products or services to members (for example, our claims processors); these persons are trained on the importance of safeguarding this information and must comply with our procedures and applicable law. We meet strict physical, electronic and procedural security standards to protect personal information and maintain internal procedures to promote the integrity and accuracy of that information.
How Family & Cosmetic Dentistry Uses and Discloses Personal Information. In order to provide your dental coverage, we need to collect personal information about you. We obtain that information from many sources, including your employer or your Fund office, other insurers, third party administrators (TPAs) and dental providers.
We may use and disclose personal information about you for the following reasons:
Health Care Operations. In order to run our dental care business we may use and disclose your personal information for operational activities such as quality assessment and improvement; licensing; accreditation, performance measurement and outcomes assessment; and preventive health. For example, we may use the information to determine how many dentists performed root canals in your geographic area. Other operational uses and disclosures include underwriting and rating; fraud detection; issuing policy and certificates of coverage and other general administration, including data and information systems management and customer service.
Payment. In order to process and pay for your dental services, we may use and disclose your personal information in various ways, including utilization review and pre-determination of benefits, coordinating care, determining eligibility, collecting premiums, calculating co-payments and responding to complaints, appeals and requests for external review. For example, we may use your dental history to determine if a crown is necessary or appropriate and during the process, we may disclose information to your provider. We also mail an explanation of your benefits to the address we have on record for the member.
Treatment. We may disclose information to dentists and other health care providers who take care of you. For example, we may disclose information about you to a specialist when you are referred by a general dentist for treatment.
Disclosures to Other Covered Entities. We may disclose personal information to other covered entities, or to business associates of those entities, for treatment, payment and certain health care operations purposes. For example, we may disclose your personal information to other health plans maintained by your employer or Fund if it has been arranged for us to do so in order to have certain expenses reimbursed.
Additional Reasons for Disclosure
We may also use or disclose dental information about you to provide you with treatment alternative or other dental-related benefits and services. We may also disclose your information in support of:
Plan Administration - to your employer or Fund, when we have been informed that appropriate language has been included in your plan documents, or when summary data is disclosed to assist in rating or amending a group dental plan.
Business Associates - to persons who provide services to us and assure us they will protect the information in a manner that we protect the information.
Industry Regulation - to state insurance departments, state-managed Care departments, dental Boards, U.S. Food and Drug Administration, U.S. Department of Labor and other government agencies that regulate us.
Law Enforcement - to federal, state and local law enforcement officials
Legal Proceedings - in response to a court order or other lawful process.
Public Welfare - to address matters of public interest as required or permitted by law (e.g., child abuse or neglect, threats to public health and safety and national security).
Disclosures to Others Involved in Your Dental Care. We may also disclose your dental Information to a relative, a friend, the participant of your dental plan or any other person you identify, provided the information is directly relevant to that person's involvement with your dental care or payment for that care. For example, if a family member calls us with prior knowledge of a dental claim, we may confirm whether or not the claim has been received and paid. You have the right to stop or limit this kind of disclosure by calling the toll-free Member Services number in your Certificate of Coverage.
If you are a minor, you also may have the right to block parental access to your dental information in certain circumstances, if permitted by state law. You can contact us using the toll-free Member Services number - or you may have your provider contact us.
Uses and Disclosures Requiring Your Written Authorization. In all situations other than those described above, we will ask for your written authorization before using or disclosing personal information about you. If you have given us an authorization, you may revoke it at any time, if we have not already acted on it. If you have questions regarding authorizations, please call the toll-free Member Services number in your Certificate of Coverage.
Your Legal RightsThe federal privacy regulations give you the right to make certain requests regarding your dental health information. You may ask us to:
Communicate with you in a certain way or at a certain location. For example, if you are an adult, you may ask us to send your dental claims to a different address than that of the participant, we will accommodate reasonable requests.
Restrict the way we use or disclose your dental information in connection with health care operations, payment and treatment. We will consider, but may not agree to, such requests, you also have the right to ask us to restrict disclosures to persons involved in your dental care.
Inspect and obtain a copy of dental information that is contained in a designated record set, which includes the dental or other records maintained and used in making enrollment, payment, claims adjudication, dental management and other decisions. We may ask you to make your request in writing, may charge a reasonable fee for producing and mailing the copies and, in certain cases, may deny the request.
Amend dental information in the designated record set. Your request must be in writing and must include the reason for the request. If we deny the request, you may file a written statement of disagreement.
Provide a list of certain disclosures we have made about you, such as disclosures of dental information to government agencies that license us. Your request must be in writing. If you request such an accounting more than once in a 12-month period, we may charge a reasonable fee.
Obtain a paper copy of this notice by contacting us at the number in your Certificate of Coverage.
ComplaintsYou also have the right to file a complaint if you think your privacy rights have been violated. To do so, you may write or call Family & Cosmetic Dentistry, and direct your complaint to the HIPAA Complaint Contact Person. You may also write to the secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.
How to Contact UsYou can contact us using the toll-free Member Services number in your Certificate of Coverage, or you can write to:
Privacy Officer at Group Dental Service Family & Cosmetic Dentistry, Inc. 111 dental waySuite 000Dentistville, California 000000.
Family & Cosmetic Dentistry's Legal ObligationsThe federal privacy regulations require us to keep personal information about you private, to give you notice of our legal duties and privacy practices and to follow the terms of the notice currently in effect.
Notice Subject to ChangeWe may change the terms of this notice and our privacy policies at any time. If we do, the new terms and policies will be effective for all of the information that we already have about you, as well as any information that we may receive or hold in the future-.We will send a revised Notice to all current participants within 60 days of any material change to the Notice. In addition, we will notify all current participants at least once every three years of the availability of the notice and how to obtain the Notice.
Personal InformationFamily & Cosmetic Dentistry does not collect personal information about you on its Web site(s) unless you voluntarily provide such information. By personal information, we mean information that identifies you as an individual, such as your name, address or email address.
In cases where we do collect personal information that you voluntarily provide, we will not sell, share, trade, rent, distribute or otherwise disclose that information unless expressly authorized by you, or unless it is necessary for our contractors to perform certain functions, or as required or permitted by law. In any such instance, the recipient of that information will be required to protect the information and use it only for the purpose for which it was provided.
EmailTo protect your privacy, please do not correspond with Family & Cosmetic Dentistry via email if you consider the content of those communications to be confidential. Non-encrypted email communications can be viewed while in transit.
CookiesLike most commercial Web sites, Family & Cosmetic Dentistry may use "cookies" - a small piece of data that is stored on an end user's hard drive. It is not personally identifiable to you, and has no ability to read other information on your computer. Its purpose is to enhance site visitors' experience by recognizing repeat users and better serving those users when they return to the site. Most Internet browsers can easily be configured to notify you when a Web site is preparing to send a cookie, providing the option to refuse that piece of data.
Data SecurityFamily & Cosmetic Dentistry adheres to strict standards to protect non-public information at Family & Cosmetic Dentistry Web sites against unauthorized access. Those safeguards are physical, administrative and technical. We require unique usernames and passwords that must be entered each time a plan member or employer logs on to maintain data integrity, prevent unauthorized access, and ensure appropriate use.
Tracking Other Information Family & Cosmetic Dentistry and its contractors may track traffic on Family & Cosmetic Dentistry Web site(s) through information such as number of visitors on the site and on certain pages. That data is aggregate only, and does not identify you personally. We use that information to improve the usefulness of the site.
Change to this PolicyThis policy may change from time to time, without notice. It is not intended to create any contractual or other legal rights or obligations on behalf of any party.
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