Advantage Dental Plan - Privacy Notice

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.

NOTICE OF PRIVACY PRACTICES

Effective April 14, 2003

At Advantage Dental Plan, Inc., places the highest respect for the the privacy of your personal financial and health information.  ADP is sincere in our promise to ensure the privacy of your information in a responsible and professional way.  ADP also is required by law to maintain the privacy of your personal financial and health information, provide you with this notice, and abide by the terms of this notice.

Should any of ADP's privacy practices change, ADP reserves the right to change the terms of this notice and to make the new notice effective for all personal financial and health information we maintain.  Once revised, ADP will let you know that a change has been made and will post the notice on our website at www.advantagedental.com.  You may also ask that the new notice be mailed to you.

This notice explains how ADP uses information about you and when ADP can share that information with others.  It also informs you of your rights as a member of our Plan.  Finally, this notice gives you information about how you can exercise these rights.

How We Use or Share Information

ADP uses your personal financial and health information and may share it with others as part of your treatment, payment for your treatment, and for business operations.  The following are ways we may use or share your information:

- ADP will use the information to help pay your dental claims that have been submitted to us by your providers for payment.

- ADP may use the information to process your premium payments.

- ADP may share your information with our attorney, our accountants, our agents, or others who help us conduct business.  ADP will not share your information with these groups unless they agree to keep it protected.

- ADP may share your information with your providers to help them provide care to you.  For example, if you are in the hospital, ADP may give them access to health records sent to us by your providers.

- ADP may use or share your information with others to help manage your health care.  For example, ADP might talk to your provider to suggest a disease management or wellness plan that could help improve your health.

In addition, ADP may use or share information about you:

- To let you know about alternative health treatments and programs or about health-related products and services that you may be interested in.  For example, ADP may send out newsletters that let you know about "healthy living" alternatives such as stop-smoking.

- To an employee benefit plan through which you receive health benefits.  ADP will not share your detailed health information with your benefit plan unless they promise to keep it private.

There are also state and federal laws that may require us to share your personal information with others.  ADP may need to give your information to others for the reasons below:

- ADP may have to give your information to law enforcement agencies.  For example, ADP has to report when we believe there has been child abuse or neglect or domestic violence.

- ADP may be required by a court or administrative agency to give your information due to a search warrant or subpoena.

- ADP may share your health information with public health agencies if we believe there is a serious threat to health or safety.

- ADP may be required to share health information on your job-related injuries due to your state worker compensation laws.

- ADP may share your health information with the Food and Drug Administration.  They are responsible for investigation or tracking of prescription drug and medical device problems.

ADP may have to share your information with state and federal agencies that regulate us, such as the US Department of Health and Human Services and the Oregon Insurance Division.

If ADP uses or shares your personal information for reasons other than the above, ADP will first get your written permission.  If you give us written permission and then change your mind, you may cancel your written permission at any time.  ADP will honor the revocation except to the extent that we have already relied on your permission.

If ADP shares your information as a result of your written permission, it may be re-disclosed by the party you permitted release to, and may no longer be protected by state and federal privacy rules.  Federal or state law may restrict re-disclosure of HIV/AIDS test or result information, mental health information, genetic information and drug/alcohol diagnosis, treatment or referral information.

Your Rights

You have certain rights with respect to your personal financial and health information.  These include:

- You have the right to ask us to restrict how ADP will use or share your information for treatment, payment, or health care operations.  You also have the right to ask ADP to restrict the information we give to persons involved in your care.  While ADP may honor your request for restrictions, ADP is not required to agree to these restrictions.

- You have the right to ask for confidential communications of your information.  You may request that ADP disclose your information by alternative means or at alternative locations.  ADP will accommodate reasonable requests by you as explained above.  ADP may require that you make your request in writing.

- You have the right to inspect and obtain a copy of the information that ADP maintains about you in a designated record set.

However, you may not be allowed to inspect or obtain a copy of your information that is:

· Contained in psychotherapy notes.
	· Compiled in reasonable anticipation of, or for use in, a civil criminal or administrative action or proceeding.
	· Subject to the Clinical Laboratory Improvements Amendments of 1988, 42 U.S.C. 263a, to the extent the provisions of access to the individual would be prohibited by law or exempt from the Clinical Laboratory Improvements Amendments of 1988, pursuant to 42 CFR 493.3(a)(2).

Also, in certain cases, ADP may choose not to grant your request to inspect or obtain a copy of your information.  If ADP denies your request, you will be informed in know in writing and will give you the right to have the denial reviewed.

ADP may require that your request be made in writing.  ADP will act on your request no more than 30 days after we receive it.  If the information you ask for is not maintained or accessible to us on-site, ADP will act on your request no later than 60 days after ADP receives it.  If ADP needs more time, ADP will let you know of the reasons for the delay and the date by which we will be able to complete action on your request.

If you ask for a copy, ADP will charge you a reasonable fee based on copying and postage costs.  You may ask for a copy of the portion of your enrollment and claim record related to an appeal or grievance free of charge.

- You have the right to ask ADP to amend information maintained about you in a designated record set.  ADP may require that your request be in writing and that you give a reason for your request.  ADP will act on your request no later than 60 days after ADP  receives it.  If ADP is unable to act in 60 days, ADP may extend that time by no more than 30 days.  If ADP needs to extend this time, ADP will let you know of the delay and the date by which ADP will complete action on your request.

If ADP makes the amendment, ADP will let you know that it was made, and ADP will obtain your agreement to have us inform those you have identified with whom the amendment needs to be shared.  ADP will inform these persons of the amendment.

If ADP denies your request to amend, ADP will let you know in writing why ADP denied the request.  The denial will explain your right to file a written statement of disagreement.  ADP has a right to rebut your statement.  However, you have the right to request that your written request, our written denial and your statement of disagreement be included with your information for any future disclosures.

- You have the right to receive an accounting of certain disclosures of your information made by ADP during the six years prior to your request.  The accounting may not include disclosures:

· For use in treatment, payment, and health care operations.
	· Made to you.
	· Incident to a use or disclosure otherwise allowed.
	· Made on the basis of your permission.
	· For a facility's directory or to persons involved in your care or for other notification reasons.
	· For national security or intelligence reasons.
	· To correctional institutions or law enforcement officials.
	· Made as part of a limited data set for use in research, public health, or health care operations.
	· Made prior to April 14, 2003.

Also, if ADP shares your information for research reasons on the basis of a waiver of authorization, ADP  does not need to account for each disclosure of your information.  Instead, ADP will give to you:

· The name of the research activity.
	· An account of the research activity, including the purpose for the research and the basis for selecting certain records.
	· An account of the type of health information that was shared.
	· The date or range of time when such disclosure was made.
	· The name, address, and phone number of the entity that sponsored the research and the researcher with whom the information was shared.

ADP will act on your request for an accounting in 60 days.  ADP may need more time to act on your request, and then may take up to 30 more days.

Your first accounting will be free.  ADP will give to you one free accounting on request every 12 months.  However, if you request a second accounting within 12 months of receiving your free accounting, ADP may charge you a fee.  ADP will inform you in advance of the fee and will give you a chance to void or change your request.

Exercising Your Rights
- You have a right to receive a paper copy of this notice on request at any time.  You can also view a copy of the notice on our web site at www.advantagedental.com.

- If you have any questions about this notice or our privacy practices, please call your Member Services Team at 1-866-268-9615.  ADP office is open Monday through Friday from 8 a.m. to 5 p.m.  You can also send us questions by email at memberservices@e-adpi.com.

- If you feel your privacy rights have been abused in any way, you may file a complaint with ADP by calling your Member Services Team at 1-866-268-9615.  You may also let the Office of Civil Rights, U.S. Department of Health and Human Services know of your complaint.  We will not take any action against you for filing a complaint.  You may contact the Office of Civil Rights at:

Office for Civil Rights
	U.S. Department of Health and Human Services
	200 Independence Ave SW
	Room 509F, HHH Building
	Washington DC  20201

OCR Hotlines Voice:  1-800-368-1019
	ocrmail@hhs.gov

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