Summary notice of privacy practices

This summary describes how medical information about you may be used and shared with others. It also explains how you can get this information. Please read carefully. For more details, view the complete notice of privacy practices (PDF).

Keystone First VIP Choice (HMO D-SNP) is required by law to protect the privacy of your health information. Keystone First VIP Choice would like to tell you about its policies to protect your information. Health care providers use members' medical information during treatment, and during payment processing with us.

Keystone First VIP Choice may use and disclose your Protected Health Information (PHI) to help you get your health care services and to pay our providers for giving you care. Many steps are taken to make sure this information is protected. Keystone First VIP Choice is not allowed to use or share your medical information without you saying in writing that we can, except for the reasons listed below:

Treatment of the patient
Example: Health care providers talking about a patient's treatment.

Making a payment
Example: Our claims processing department using medical information to make payments to providers.

Health care operations
Example: Identifying members with certain chronic illnesses so we can send treatment information to them or their providers.

Some other examples of how Keystone First VIP Choice may use or share your PHI include:

• Legal requirements.
• Public health activities.
• Reporting abuse.
• Law enforcement.
• Research.
• Providing information to you.
• Avoiding serious threat.

Sometimes we are required to get your authorization so that we can use or share your PHI. You can cancel your authorization at any time. But we cannot stop the use or sharing of any information we used or shared before you canceled your authorization. You may get a copy of your PHI in our records. You may also get a description of some ways we use your PHI.

For a copy of the full notice of privacy practices and/or for any questions or comments regarding PHI, please call Member Services.

• Authorization for Sharing of Health Information (PDF)

Use this form to give us permission to discuss or disclose your protected health information (PHI) to the individual or organization that you have named on the form.