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«STATE OF NEW JERSEY DEPARTMENT OF THE TREASURY DIVISION OF PENSIONS AND BENEFITS Horizon HMO MEMBER HANDBOOK FOR EMPLOYEES AND RETIREES ENROLLED IN ...»

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We cannot amend demographic information, treatment records or any other information created by others. If members would like to amend any of their demographic information, please contact your personnel office. To amend treatment records, a member must contact the treating physician, facility, or other provider that created and/or maintains these records.

The SHBP or SEHBP may deny the member's request if: 1) we did not create the information requested on the amendment; 2) the information is not part of the designated record set maintained by the SHBP or SEHBP; 3) the member does not have access rights to the information; or 4) we believe the information is accurate and complete. If we deny the member’s request, we will provide a written explanation for the denial and the member's rights regarding the denial.

Right to an Accounting of Disclosures: Members have the right to receive an accounting of the instances in which the SHBP, SEHBP, or our Business Associates have disclosed member PHI. The accounting will review disclosures made over the past six years. We will provide the member with the date on which we made a disclosure, the name of the person or entity to whom we disclosed the PHI, a description of the information we disclosed, the reason for the disclosure, and certain other information. Certain disclosures are exempted from this requirement (e.g., those made for treatment, payment or health benefits operation purposes or made in accordance with an authorization) and will not appear on the accounting.

Right to Request Restrictions: The member has the right to request that the SHBP or SEHBP place restrictions on the use or disclosure of their PHI for treatment, payment, or health care operations purposes. The SHBP and SEHBP are not required to agree to any restrictions and in some cases will be prohibited from agreeing to them. However, if we

NEW JERSEY DIVISION OF PENSIONS AND BENEFITS —

do agree to a restriction, our agreement will always be in writing and signed by the Privacy Officer. The member request for restrictions must be in writing. A form can be obtained by using the contact information found at the end of this Notice.

Right to Restrict Disclosure: The member has the right to request that a provider restrict disclosure of PHI to the Programs or Business Associates if the PHI relates to services or a health care item for which the individual has paid the provider in full. If payment involves a flexible spending account or health savings account, the individual cannot restrict disclosure of information necessary to make the payment but may request that disclosure not be made to another program or health plan.

Right to Receive Notification of a Breach: The member has the right to receive notification in the event that the Programs or a Business Associate discover unauthorized access or release of PHI through a security breach.

Right to Request Confidential Communications: The member has the right to request that the SHBP or SEHBP communicate with them in confidence about their PHI by using alternative means or an alternative location if the disclosure of all or part of that information to another person could endanger them. We will accommodate such a request if it is reasonable, if the request specifies the alternative means or locations, and if it continues to permit the SHBP or SEHBP to collect premiums and pay claims under the health plan.

To request changes to confidential communications, the member must make their request in writing, and must clearly state that the information could endanger them if it is not communicated in confidence as they requested.

Right to Receive a Paper Copy of the Notice: Members are entitled to receive a paper copy of this Notice. Please contact us using the information at the end of this Notice.

Questions and Complaints If you have questions or concerns, please contact the SHBP or SEHBP using the information listed at the end of this Notice.

If members think the SHBP or SEHBP may have violated their privacy rights, or they disagree with a decision made about access to their PHI, in response to a request made to amend or restrict the use or disclosure of their information, or to have the SHBP or SEHBP communicate with them in confidence by alternative means or at an alternative location, they must submit their complaint in writing. To obtain a form for submitting a complaint, use the contact information found at the end of this Notice.

Members also may submit a written complaint to the U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201.

The SHBP and SEHBP support member rights to protect the privacy of PHI. It is your right to file a complaint with the SHBP, SEHBP, or with the US Department of Health and Human Services.

106 — HORIZON HMO MEMBER HANDBOOK

Contact Office:

Division of Pensions and Benefits — HIPAA Privacy Officer

Address:

State of New Jersey Department of the Treasury Division of Pensions and Benefits PO Box 295 Trenton, NJ 08625-0295 E-mail: hipaaform@treas.nj.gov

–  –  –

Internet Address: www.nj.gov/treasury/pensions/health-benefits.shtml E-mail Address: pensions.nj@treas.nj.gov Please indicate on all correspondence whether you are a SHBP or SEHBP member.

Telephone Numbers Horizon Blue Cross Blue Shield of New Jersey

Division of Pensions and Benefits:

Office of Client Services and Automated Information System.................(609) 292-7524 TDD Phone (Hearing Impaired)

State Employee Advisory Service (EAS) 24 hours a day

New Jersey State Police Employee Advisory Program (EAP)

NEW JERSEY DIVISION OF PENSIONS AND BENEFITS —

Rutgers University Personnel Counseling Service Employee Advisory Program (EAP)

New Jersey Department of Banking and Insurance Individual Health Coverage Program Board

Consumer Assistance for Health Insurance

New Jersey Department of Human Services Pharmaceutical Assistance to the Aged and Disabled (PAAD).........1-800-792-9745 New Jersey Department of Health and Senior Services Division of Aging and Community Services

Insurance Counseling

Independent Health Care Appeals Program

Centers for Medicare and Medicaid Services New Jersey Medicare — Part A and Part B

110 — HORIZON HMO MEMBER HANDBOOK

HEALTH BENEFITS PROGRAM PUBLICATIONS

Fact sheets, handbooks, and other publications are available for viewing or printing over the Internet at: www.nj.gov/treasury/pensions General Publications Summary Program Description booklet — an overview of the SHBP and SEHBP Plan Comparison Summary — Out-of-pocket cost comparison charts for State employees, local government employees, local education employees, and all retirees.

Fact Sheet #11, Enrolling in Health Benefits Coverage When You Retire Fact Sheet #23, Health Benefits Coverage and Medicare Parts A & B for Retirees Fact Sheet #25, Employer Responsibilities under COBRA Fact Sheet #26, Health Benefits Options upon Termination of Employment Fact Sheet #30, Continuation of Health Benefits Insurance under COBRA Fact Sheet Fact Sheet #31, Benefits at Termination of Employment Fact Sheet #37, Employee Dental Plans Fact Sheet #47, Retired Health Benefits Coverage under Chapter 330 (PFRS, LEO) Fact Sheet #51, Continuing Coverage for Over Age Children with Disabilities Fact Sheet #60, Voluntary Furlough Program Fact Sheet #66, Health Benefits Coverage for Part-Time Employees Fact Sheet #69, SHBP Coverage for State Intermittent Employees Fact Sheet #71, Benefits under the Domestic Partnership Act Fact Sheet #73, Retiree Dental Plans Fact Sheet #74, Health Benefit Coverage of Children until Age 31 under Chapter 375 Fact Sheet #75, Civil Unions Member Handbooks HORIZON HMO Member Handbook Horizon HMO Member Handbook HORIZON HDHP Member Handbook Aetna Freedom and Value HD Plans Member Handbook Aetna HMO Member Handbook Prescription Drug Plans Member Handbook Employee Dental Plans Member Handbook Retiree Dental Plans Member Handbook

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