Summary Plan Description

Teamsters Local 805 Welfare Fund

SUMMARY PLAN DESCRIPTION -

HIPAA -- PRIVACY OF PROTECTED HEALTH INFORMATION

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) gives you certain rights with respect to your health information, and it also imposes certain obligations on the Fund as a group health plan. The following describes the ways your health information is protected under HIPAA when that health information is disclosed to or used or disclosed by the Board of Trustees (the “Board”), in its capacity as the sponsor of the Fund. These rules do not apply to any disability, death or other non-health benefits provided under the Fund.

A complete description of your rights under HIPAA is available in the Fund’s Notice of Privacy Practices which the Fund was required to distribute to you. The Fund also maintains a Notice of Privacy Practices which is available upon request from the Fund Office. The statement that follows is not intended and cannot be considered to be the Fund’s Notice of Privacy Practices.
Your “protected health information” is information about you, including demographic information that –

is created or received by the Fund, or by your health care provider or a health care clearinghouse (and is not related to your non-health benefits under the Fund, e.g., disability);
relates to your past, present, or future physical or mental condition;
relates to the provision of health care to you;
relates to the past, present, or future payment for the provision of health care to you; and
identifies you in some manner.

Since the Fund is required to keep your protected health information confidential, before the Fund can disclose any of your health information to the Board as the sponsor of the Fund, the Board must agree to keep your protected health information confidential. In addition, the Board must agree to handle your protected health information in a way that enables the Fund to comply with HIPAA. Toward that end, the Board hereby certifies to the Fund that the Plan documents have been amended to incorporate the following provisions, and the Board agrees to the following rules in connection with your protected health information received from, or on behalf of the Fund:

The Board understands that the Fund will only disclose your protected health information to the Board for the Board’s use in Fund administrative functions and such disclosures explained in the Notice of Privacy Practices distributed to you by the Fund. In all cases, the Board will receive only the minimum necessary amount of protected health information necessary for the Board to perform Fund administrative functions. Such Fund administrative functions may include assisting participants in filing claims for benefits under the Fund, or filing an appeal of a denied claim. The Board may also receive protected health information as necessary for the Board to perform its fiduciary and administrative duties as required by ERISA.
The Board will not use or disclose your protected health information for any reason other than for the Fund’s administrative functions, as otherwise expressly permitted in this SPD, as required by law, or if the Board has your written authorization.
The Board will not use or disclose protected health information for employment-related actions or decisions or in connection with any pension or other employee benefit plan sponsored by the Board, unless it receives your express written authorization.
If the Board discloses to any of its agents or subcontractors any of your protected health information that it receives from the Fund, the Board will require the agent or subcontractor to agree to the same restrictions that govern the Board’s use or disclosure of your protected health information under this SPD.
The Board will promptly report to the Fund’s Privacy Officer if it becomes aware of any use or disclosure of your protected health information that is inconsistent with the uses and disclosures allowed under this SPD.
The Board will allow you or the Fund to inspect and copy your protected health information that is in its custody and control to the extent required of the Fund under HIPAA. (You should review the Notice of Privacy Practices to learn more about your rights to receive copies of your health information maintained by the Fund.)
The Board will make your protected health information available to you, or to the Fund, in order to allow you or the Fund to amend the information, to the extent required under HIPAA, and the Board will incorporate any such amendments that the Fund has accepted in accordance with HIPAA. (You should review the Notice of Privacy Practices to learn more about your rights to request an amendment to your protected health information maintained by the Fund.)
The Board will keep a written record of certain types of disclosures that it makes, if any, of your protected health information for reasons other than for your medical treatment, payment for that medical treatment, or health care operations, or with your written permission. This written disclosure record will include those types of disclosures made during at least the previous six years, except only disclosures made after April 14, 2003 must be listed. The Board will make this disclosure record available to the Fund so that the Fund can provide you, upon request, with a copy of that list of disclosures. (You should review the Notice of Privacy Practices to learn more about your rights to request a log of certain types of disclosures of your protected health information made by the Fund.)
The Board will make available its internal practices, books and records relating to its use and disclosure of protected health information that it receives in its capacity as the sponsor of the Fund and to the Secretary of the U.S. Department of Health and Human Services to determine the Fund’s compliance with HIPAA.
The Board will, if feasible, return or destroy all protected health information received from the Fund in whatever form or medium (including in any electronic medium under the Board’s custody or control) when protected health information is no longer needed for the Fund administration functions for which the disclosure was made, and the Board will retain no copies. This includes all copies of any data or compilations derived from, and allowing identification of you or your beneficiary who is the subject of, the protected health information. If it is not feasible to return or destroy all of the protected health information, the Board will limit the use or disclosure of any protected health information it cannot feasibly return or destroy to those purposes that make the return or destruction of the information infeasible.
If any of the Fund Office employees, workforce or individual Trustees who have access to use or disclose your protected health information in violation of HIPAA and the rules set forth in this SPD, those employees and workforce or Trustees will be subject to disciplinary action and sanctions, up to and including the possibility of termination of employment or affiliation with the Board. If the Board becomes aware of any such violations, it will promptly report the violation to the Fund’s Privacy Officer and will cooperate with the Fund to correct the violation, to impose appropriate sanctions and to mitigate any harmful effects on you.

There are also some special rules under HIPAA related to “electronic health information.” Electronic health information is generally protected health information that is transmitted by, or maintained in, electronic media. “Electronic media” includes electronic storage media, including memory devices in a computer (such as hard drives) and removable or transportable digital media (such as magnetic tapes or disks, optical disks and digital memory cards). It also includes transmission media used to exchange information already in electronic storage media, such as the internet, an extranet (which uses internet technology to link a business with information accessible only to some parties), leased lines, dial-up lines, private networks and the physical movement of removable/transportable electronic storage media.

Please be advised that, as required by HIPAA, no later than April 20, 2005, the Board will take additional action with respect to the implementation of security measures (as defined in 45 Code of Federal Regulations § 164.304) for electronic protected health information. Specifically, the Board will:

Implement administrative, physical and technical safeguards that reasonably and appropriately protect the confidentiality, integrity and availability of the electronic protected health information that it creates, receives, maintains or transmits on behalf of the Fund;
Ensure that the adequate separation required to exist between the Fund and the Board is supported by reasonable and appropriate administrative, physical and technical safeguards in its information systems;
Ensure that any agent, including a subcontractor, to whom it provides electronic protected health information, agrees to implement reasonable and appropriate security measures to protect that information;
Report to the Fund if it becomes aware of any attempted or successful unauthorized access, use, disclosure, modification or destruction of information or interference with system operations in its information system; and
Comply with any other requirements that the Secretary of the U.S. Department of Health and Human Services may require from time to time with respect to electronic protected health information by the issuance of additional regulations or other guidance pursuant to HIPAA.

If you have any further questions about your privacy rights under HIPAA, please contact:

ONEIDA RODRIGUEZ
PRIVACY OFFICER
LOCAL 805 WELFARE FUND
44-61 11TH STREET, 3RD FLOOR
LONG ISLAND CITY, NY 11101