h i p a a privacy requirements sample employer notice（h i p隐私需求样品的雇主的注意）（5页）.doc

Notice Of Privacy Practices 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. This Notice of Privacy Practices (“Notice”) applies to Protected Health Information (defined below) associated with Group Health Plans (defined below) provided by [Insert name of Company] to its employees, its employee’s dependents and, as applicable, retired employees. This Notice describes how [INSERT NAME OF COMPANY], collectively we, us, or our [or, if appropriate, insert short name of company] may use and disclose Protected Health Information to carry out payment and health care operations, and for other purposes that are permitted or required by law. We are required by the privacy regulations issued under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) to maintain the privacy of Protected Health Information and to provide individuals covered under our group health plan with notice of our legal duties and privacy practices concerning Protected Health Information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all Protected Health Information maintained by us. If we make material changes to our privacy practices, copies of revised notices will be mailed to all policyholders then covered by the Group Health Plan. Copies of our current Notice may be obtained by contacting [INSERT NAME OF COMPANY] at the telephone number or address below, or on our Web site at Insert Web site address. DEFINITIONS Group Health Plan means, for purposes of this Notice, the following employee benefits that we provide to our employees, employee dependents and, as applicable, retired employees: [Insert the appropriate coverages you provide which might include major medical coverage, dental cov