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NEAS Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL (MENTAL HEALTH) INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
PLEASE REVIEW IT CAREFULLY.
NEAS, Inc. and NEAS Western Division, Inc., hereafter referred to as NEAS, is a provider of Employee Assistance And Work/Life Program services. When you
contact NEAS, you usually provide information, which individually identifies you, and you may provide health information.
This notice describes how NEAS may use and disclose that information.
NEAS may use and disclose your health information, without your permission, for treatment, payment,
and certain health care operations activities and, when required or authorized by law, for public health and interest
activities, law enforcement, judicial and administrative proceedings, research, and certain other public benefit functions.
NEAS may not disclose mental health treatment records for certain of these purposes without your written permission.
Your health information, including mental health treatment records, will be available to all of
NEAS' counseling and professional staff in order to provide immediate assistance and case management services 24 hours
per day.
In order to facilitate treatment, NEAS may disclose your mental health treatment records to
other health care providers, with all individually identifying information removed.
NEAS will not otherwise use or disclose your health information without your written authorization.
You have the right to examine and receive a copy of your health information, to receive an accounting
of certain disclosures NEAS may make of your health information, and to request that NEAS amend, further restrict
use and disclosure of, or communicate in confidence with you about your health information.
Please review this entire notice for details about the uses and disclosures NEAS may make of your
health information, about your rights and how to exercise them, and about complaints regarding or additional
information about our privacy practices.
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your health information.
We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning
your health information. We must follow the privacy practices that are described in this notice while it is in effect.
This notice takes effect April 1, 2003, and will remain in effect unless we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time,
provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy
practices and the new terms of our notice effective for all health information that we maintain, including health
information we created or received before we made the changes. Before we make a significant change in our privacy
practices, we will change this notice, post the revised notice at each of our service delivery sites, and make the
new notice available to our clients and others upon request.
You may request a copy of our notice at any time. For more information about our privacy practices,
or for additional copies of this notice, please contact us using the information at the end of this notice.
Uses and Disclosures of Health information
Treatment: We may use your health information, without your permission, to treat you.
We may disclose your health information, without your permission, to a health care provider for your treatment.
These treatment activities include coordination of your care with other providers, with health plans and with others,
consultation with other providers, and referral to other providers related to your care.
Payment: We may use and disclose your health information, without your permission, to
obtain or provide reimbursement for health care we provide to you, including submitting claims to health plans,
other insurers or others. These payment activities include justifying our charges for and demonstrating the medical
necessity of the care we deliver to you, determining your eligibility for health plan benefits for the care we furnish
to you, obtaining precertification or preauthorization for your treatment or referral to other health care providers,
participating in utilization review of the services we provide to you, and the like. We may disclose your health
information to another health care provider or to a health plan for that provider or plan to obtain payment or engage
in other payment activities with respect to your health care.
We may need your written permission to disclose information taken from your mental health treatment
records for payment purposes.
Health Care Operations: We may use and disclose your health information for certain of our
health care operations. Health care operations include:
health care quality assessment and improvement activities;
reviewing and evaluating health care provider and health plan performance, qualifications and competence, health
care training programs, health care provider and health plan accreditation, certification, licensing and credentialing
activities;
conducting or arranging for service reviews, audits, and legal services, including fraud and abuse detection and
prevention; and
business planning, development, management, and general administration, including customer service, de-identifying
health information, and creating limited data sets for health care operations, public health activities, and research.
With your written permission, we may disclose your health information to a health plan or another
health care provider who is subject to federal privacy protection laws, as long as the provider or plan has or had a
relationship with you and the health information is for that provider’s or plan’s health care quality assessment and
improvement activities, competence and qualification evaluation and review activities, or fraud and abuse detection
and prevention.
We may need your written permission to disclose health information or information taken from your
mental health treatment records or HIV test results for certain health care operations
Your Authorization: You may give us written authorization to use your health information or
to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time.
Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect. Unless
you give us a written authorization, we will not use or disclose your health information for any purpose other than
those described in this notice.
Family, Friends, and Others Involved in Your Care or Payment for Care: With your written permission,
we may disclose your confidential health information to a family member, friend or any other person you involve in your
health care or payment for your health care. We will disclose only the health information that is relevant to the
person’s involvement.
Health-Related Products and Services: We may use your health information to contact you to
provide appointment reminders, and to communicate with you about treatment alternatives and other health-related
benefits and services that may be of interest to you. These communications may describe health-related products or
services that we provide, payment for such products or services, and the health care providers in a provider or
health plan network.
Public Health and Benefit Activities: We may use and disclose your health information,
without your permission, when required by law, and when authorized by law for the following kinds of public
health and interest activities, judicial and administrative proceedings, law enforcement, research, and other public
benefit functions:
for public health, including to report disease and vital statistics, child abuse, and adult abuse, neglect or
domestic violence;
to avert a serious and imminent threat to health or safety;
for health care oversight, such as activities of state licensing and peer review authorities, and fraud prevention
enforcement agencies;
for research;
in response to court and certain administrative orders and other lawful process;
to law enforcement officials with regard to crime victims, crimes on our premises, crime reporting in emergencies,
and identifying or locating suspects or other persons;
to coroners, medical examiners, and (with respect to HIV test results) funeral directors;
to the military, to federal officials for lawful intelligence, counterintelligence, and national security activities,
and to correctional institutions and law enforcement regarding persons in lawful custody; and
as authorized by state worker’s compensation laws.
You may be able to opt out of use or disclosure of your health information for (a) research purposes
or (b) pursuant to a written request from a government agency, unless the disclosure is required by law.
We may not disclose certain confidential health information or mental health treatment records
for certain of these purposes without your written permission, unless required by law.
Individual Rights
Access: You have the right to examine and to receive a copy of your health information, with
limited exceptions. You must make a written request to obtain access to your health information. You should submit
your request to the contact identified at the end of this notice. You may obtain a form from that contact to make your
request.
We may charge you reasonable, cost-based fees for a copy of your health information, for mailing the
copy to you, and for preparing any summary or explanation of your health information you request. Contact us using the
information at the end of this notice for information about our fees.
Disclosure Accounting: You have the right to a list of instances after April 13, 2003 in which we
disclose your health information for purposes other than treatment, payment, health care operations, as authorized by you,
and for certain other activities. You also have the right to a list of all written disclosures of your mental health
treatment records, unless all individually identifying information has been removed from them.
You should submit your request to the contact identified at the end of this notice. You may obtain a
form from that contact to make your request. We will provide you with information about each accountable disclosure
that we made during the period for which you request the accounting, except we are not obligated to account for a
disclosure that occurred more than 6 years before the date of your request and never for a disclosure that occurred
before April 14, 2003. If you request this accounting more than once in a 12-month period, we may charge you a
reasonable, cost-based fee for responding to your additional requests. Contact us using the information at the end of
this notice for information about our fees.
Amendment: You have the right to request that we amend your health information and mental
health treatment records. Your request must be in writing, and it must explain why the information should be amended.
You should submit your request to the contact identified at the end of this notice. You may obtain a form from that
contact to make your request.
We may deny your request only for certain reasons. If we deny your request, we will provide you a
written explanation. If we accept your request, we will make your amendment part of your health information and use
reasonable efforts to inform others of the amendment who we know may have and rely on the unamended information to your
detriment, as well as persons you want to receive the amendment.
Restriction: You have the right to request that we restrict our use or disclosure of your
health information for treatment, payment or health care operations, or with family, friends or others you identify.
We are not required to agree to your request. If we do agree, we will abide by our agreement, except in a medical
emergency or as required or authorized by law. You should submit your request to the contact identified at the end of
this notice. You may obtain a form from that contact to make your request. Any agreement we may make to a request
for restriction must be in writing signed by a person authorized to bind us to such an agreement.
Confidential Communication: You have the right to request that we communicate with you about
your health information in confidence by alternative means or to alternative locations that you specify. You must
make your request in writing. You should submit your request to the contact identified at the end of this notice.
You may obtain a form from that contact to make your request.
We will accommodate your request if it is reasonable, specifies the alternative means or location
for confidential communication, and explains how payment for our services will be handled under the alternative means
or alternative location you request for confidential communication of your health information. We will not ask you to
explain the reason for your request.
Electronic Notice: If you receive this notice on our web site or by electronic mail (e-mail),
you are entitled to receive this notice in written form. Please contact us using the information at the end of this
notice to obtain this notice in written form.
Questions and Complaints
If you want more information about our privacy practices or have questions or concerns, please contact
us using the information at the end of this notice.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision
we made about access to your health information, in response to a request you made to amend, restrict the use or
disclosure of, or communicate in confidence about your health information, you may complain to us using the contact
information at the end of this notice. You also may submit a written complaint to the Office for Civil Rights of the
United States Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, Washington, D.C. 20201.
You may contact the Office of Civil Rights’ Hotline at 1-800-368-1019.
We support your right to the privacy of your health information. We will not retaliate in any way
if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Contact: NEAS Privacy Officer
Address: N17 W24100 Riverwood Drive
Waukesha, WI 53188
Telephone: 262-574-2500
Fax: 262-523-0093
E-mail: privacyofficer@neas.com
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