Privacy Statement 

This Online Privacy Statement discloses the practices of Highmark Health Options Duals regarding information gathering and disclosure from the Highmark Health Options Duals website.

Highmark Health Options Duals may collect information regarding its website visitors and the computers they use, such as email addresses, files downloaded, home server domain names, type of computer, search engine, operating system and web browser. HHO may also collect information the visitor submits online when the visitor completes forms or surveys, sends emails, or enters other data into website fields. In the event an email is addressed to specific HHO staff or is sent using the “Contact Us” portion of this website, Highmark Health Options Duals may retain the message for up to one year. HHO uses information and discloses it to third parties as permitted by law and to the least extent necessary.

 

Highmark Health Options Duals' website and certain link sites use cookies to facilitate navigation. A cookie is a small piece of information about an Internet session that may be created when a person accesses a website. Cookies may contain a variety of information including the name of the website that issued them, what parts of the website the user accessed, passwords and user’s name. Most web browsers can be modified by users to prevent cookies from being attached.

Personal data collected by Highmark Health Options Duals may be used by HHO for many reasons, including analysis of how and when the website gets visited, for development of Highmark Health Options Duals services or for changes in the content and appearance of this website. Aggregate data on visitors' home servers may be used for internal purposes or provided to third parties. Individually identifying information, such as names, postal and email addresses, phone numbers and other personal information that visitors voluntarily provide to Highmark Health Options Duals may be added to Highmark Health Options Duals' databases and/or used for future calls and mailings regarding website updates, new products and services, upcoming events, and for other purposes that comply with federal and state law.

 

Highmark Health Options Duals may contact website visitors regarding membership issues, including specific issues affecting a member and general issues affecting groups of members, for example, changes to the Member Handbook, privacy statement, business practices or Highmark Health Options Duals policies.

Highmark Health Options Duals does not sell its member lists. Unless otherwise authorized by a visitor or validly requested by governmental authorities or legal process, Highmark Health Options Duals does not distribute its members’ specific information to outside persons or firms unless a disclosure is needed for the member’s care, payment of members’ claims, or the necessary operations of the health plan.

 

Highmark Health Options Duals may disclose to its affiliates and service providers that assist in meeting the needs of Highmark Health Options Duals member’s personal information of users that has been collected through its website, as permitted by law. Information collected by Highmark Health Options Duals affiliates and service providers may also be shared with Highmark Health Options Duals as permitted by law. Information disclosed by users online may be re-disclosed if needed to respond to the user’s requests and inquiries. Highmark Health Options Duals affiliates and service providers are required to follow no less than the privacy and confidentiality standards of law.

While Highmark Health Options Duals may provide links to other websites, a link on the Highmark Health Options Duals website is not and should not be construed as an endorsement of the content, viewpoint, policies, products or services provided or advertised on the linked site. Website visitors linking to other sites receive messages about leaving the Highmark Health Options Duals website. Once a visitor leaves the Highmark Health Options Duals website by linking to a site not maintained by Highmark Health Options Duals, the visitor should become familiar with the online privacy statement of the linked website before accessing or supplying information.

Although Highmark Health Options Duals makes reasonable efforts to protect user information from unauthorized use or alteration, users should be aware that there is always some risk in sending information over the Internet. Highmark Health Options Duals uses commercially reasonable security features; however, the confidentiality of any communication or material transmitted to/from the Highmark Health Options Duals website or email cannot be guaranteed. Highmark Health Options Duals only grants access to personal information to those employees, affiliates, service providers, and other third parties as required by law, as required to provide health care products and services or as the user permits.

 

For private health matters, members of Highmark Health Options Duals or their authorized representatives are encouraged to contact Highmark Health Options Duals by telephone at the number listed on the member identification cards.

Highmark Health Options Duals will provide website visitors with a summary of their personally identifiable information retained by Highmark Health Options Duals from online sessions, upon request by mail, email or phone. Website visitors may modify, correct, change or update personally identifiable information that Highmark Health Options Duals has collected online by contacting Highmark Health Options Duals via regular mail, email or telephone.

To the extent that Highmark Health Options Duals is able to determine the age of website visitors by their submissions to or communications with Highmark Health Options Duals, Highmark Health Options Duals will not knowingly collect or post information from individuals under age 18 without consent of a parent or guardian.

 

If registration is required on the Highmark Health Options Duals website for offered services and a visitor submits information through the website that indicates the visitor is a minor, the minor's parent or guardian will be contacted regarding the registration. If the parent or guardian agrees, the registration processing will continue. If the parent or guardian indicates a desire to withdraw the registration, Highmark Health Options Duals will provide instructions to the parent or guardian for deletion of the registration. No information collected through the Highmark Health Options Duals website from users self-identified as minors will be used knowingly for any direct marketing or promotional purposes.

The Highmark Health Options Duals Compliance Program regarding privacy and security of user information includes oversight of privacy practices, training of employees and maintenance and updates to security systems. Highmark Health Options Duals will investigate privacy and security complaints through its Compliance Officer or Security Officer.

This online Privacy Statement is subject to change at any time and should be reviewed by interested website visitors periodically. Questions or concerns regarding use of online information may be directed to Highmark Health Options Duals by clicking Contact Us or from the footer of any Highmark Health Options Duals web page.

Highmark Health Options Duals Health Personal and Health Privacy

THIS NOTICE DESCRIBES HOW HEALTH AND FINANCIAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. 

Highmark Health Options Duals is required by law to protect the privacy of your health information and non-public personal (financial) information. This protection extends to all forms of communication (oral, written, and electronic) of this information. Also, Highmark Health Options Duals is required to give you this notice about how it uses or shares (“discloses”) your health and personal (“nonpublic”) information. We are required to notify you if you are affected by a breach of unsecured health information. 

  • Doctors and health care providers who care for you
  • Other government programs such as Medicare and Medicaid to manage your benefits and payments
  • Our contracted vendors who help us provide services to you (such as member services support and pharmacy benefit management)
  • State and federal agencies that have the legal right to receive such data
  • The U.S. Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected
  • You or someone who acts for you

  • Check the quality of our services and make improvements where required
  • Conduct or arrange for medical reviews, audits, or legal services, including fraud and abuse detection and compliance programs
  • Contact you about new or changed benefits
  • Contact you for appointment reminders, medication management, or disease management programs and alternative treatments that may interest you
  • Coordinate and manage your care
  • Determine your eligibility for your plan benefits
  • Give you information about health-related benefits and services that may be of interest to you
  • Pay for your health care
  • Plan and carry out our business activities, management and general administration

  • For government health care oversight activities (such as fraud investigations, audits, and activities related to oversight of the health care system)
  • For judicial and administrative proceedings (such as in response to a court order)
  • For law enforcement purposes or when required by law, for example, locating a suspect, fugitive, material witness or missing person; complying with a court order or subpoena; and other law enforcement purposes.
  • For public health activities (such as reporting disease outbreaks; child abuse and neglect; reporting domestic violence; preventing or controlling disease, injury or disability)
  • For purposes of national security
  • For research studies that meet all privacy law requirements such as research related to the prevention of disease or disability
  • For underwriting purposes if needed, however, we are not allowed to use or share your genetic information to decide whether coverage can be given or at what price.
  • To avoid a serious and likely threat to health or safety
  • To comply with worker’s compensation or similar laws
  • To create a collection of information that can no longer be traced back to you
  • With coroners, medical examiners, funeral directors and organ donations
  • With group health plans, to coordinate plans and to permit the plan to administer benefits
  • With others involved in your health care (if you are not present or able to agree to these disclosures of your health information, we may use our professional judgment to determine whether the disclosure is in your best interest)
  • With your school when proof of immunization is required by law

Marketing 

If we receive compensation from another company for providing you with information about other products or services (other than drug refill reminders or generic drug availability), we will obtain your authorization to share information with this other company.  

Sharing information for other purposes

Highmark Health Options Duals must have your written permission (an “authorization”) to use or give out your health and claims information for any purpose that is not listed in this notice.  Giving us permission to use or give out your health and claims information will not be a condition for getting health care and will not be used to determine your eligibility for enrollment or benefits, or for paying claims. You may take back (“revoke”) your written permission at any time, except if Highmark Health Options Duals already took action based on your permission.  

Some examples of when we need your permission to use or give out your information are:

  • For fundraising
  • For selling your protected health information (PHI)

 

You have the right to:

You can ask to see or get a copy of your health or claims records and other health information we have about you. We will provide a copy or a summary of your health or claims records within 10 calendar days of your request.

You can ask us to change your health and claims records if you feel they are incorrect or incomplete. We may say “no” to your request but we’ll tell you why in writing within 60 days. If Highmark Health Options Duals cannot change your records, you may have a statement of your disagreement added to your personal medical information.

You can ask for a list (called “an accounting”) of the times we’ve shared your health information within the last six years. You must tell Highmark Health Options Duals the dates for which you are requesting the list. The list will not cover information that was given to you or your personal representative, or information given for health care payments, for Highmark Health Options Duals business operations, or for law enforcement needs.

You can ask us to contact you in a specific way, for example, on a home or office phone or to a different address. We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

You can ask us not to share certain health information for treatment, payment or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

If you have given someone medical power of attorney, or if someone is your legal guardian, that person can act for you and make choices about your health information. We will make sure the person has this authority before we take any action.

Contact us for a separate paper copy or email copy of this Notice.

What is the nonpublic information that Highmark Health Options Duals collects and shares about you?

  • It is personal but nonmedical information. For example, the information you completed on your enrollment application that identifies who you are and how you can be contacted.
  • It is information collected for a request for services by you or your doctor.
  • It is information collected to answer a question or concern from you.

With whom does Highmark Health Options Duals share your nonpublic information?

  • With health care providers, for example, physicians, hospitals, long-term care agencies, durable medical equipment providers, and pharmacies.
  • With those who plan your benefits and your care, for example, for utilization reviews; external reviews; and case management.

How does Highmark Health Options Duals protect your nonpublic information?

  • Highmark Health Options Duals does not give out your nonpublic information, except if required or permitted by law.
  • Highmark Health Options Duals does not give out your nonpublic information to anyone unrelated to providing your care under the health plan, unless you or your representative gives permission.
  • Highmark Health Options Duals does not make your nonpublic information available to anyone other than those necessary to provide medical or health plan services to you.
  • You have the right to give or withhold permission for other uses or disclosures of this information, except as required by law.

Questions and Complaints 

If you have a question about this notice or believe Highmark Health Options Duals has violated your privacy rights as stated in this notice, you can file a complaint by contacting: 

Privacy Office
Highmark Health Options Duals
P.O. Box 1991
Wilmington, DE 19899-8835

For more information on filing a complaint or your rights stated in this notice, you may call Duals Member Services at 1-855-401-8251 (TTY 711) or Duals select Member Services at 1-844-722-5837(TTY 711).  Filing a complaint will not affect your benefits. Translations services are available at no cost to you.

You may also file a complaint with the U.S. Secretary of the Department of Health and Human Services:

U.S. Department of Health and Human Services
Office for Civil Rights
Centralized Case Management Operations
200 Independence Ave., S.W.
Suite 515F, HHH Building
Washington, D.C. 20201

Customer Response Center:
Telephone: 1-800-368-1019
Fax: 202-619-3818
TDD: 1-800-537-7697
Email: OCRMail@hhs.gov

For more information, visit the Notice of Privacy Practices page on the HHS website.

Change to the terms of this notice
Highmark Health Options Duals is required to follow the terms in this privacy notice. Highmark Health Options Duals has the right to change the way your medical information is used and given out and to apply those changes to all the information we maintain about you. If Highmark Health Options Duals makes any material changes they will be posted on our website, and you will be notified within 60 days of the change.

 

These privacy practices were revised December 19, 2019.

We’re here for you 

If you need information on covered services:

Check your Medicare D-SNP benefits documents or Medicaid Member Handbook

Call Duals Member Services: 1-855-401-8251 (TTY 711), Monday–Friday, 8 a.m.–5 p.m.

Call Duals Select Member Services: 1-844-722-5837 (TTY 711), Monday-Friday, 8 a.m. – 5 p.m. 

Member Services: 1-833-957-0020 (TTY 711)

To find an in-network provider, search your D-SNP Provider Directory or search your Medicaid Provider Directory.