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. IF YOU HAVE ANY QUESTIONS OR REQUESTS, PLEASE CONTACT THE PRIVACY CONTACT LISTED AT THE END OF THIS NOTICE.
AMA Insurance Agency, Inc. (“Agency”, “we”, “our” or “us”) is committed to protecting the privacy of your health information. In conducting our business, we will create records regarding you and the services we provide to you. A federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), requires Agency to take reasonable steps to ensure the privacy of your “Protected Health Information” (as defined below) and to provide you with this notice of Privacy Practices. We will abide by the terms of our Notice of Privacy Practices currently in effect. This notice applies to American Medical Association-sponsored health plans and certain other health plans.
This notice describes your rights concerning “Protected Health Information” (“PHI”) about you. PHI is information that may identify you and that relates to (a) your past, present, or future physical or mental health or condition or (b) the past, present or future payment for your health care.
It may be necessary to change the terms of this notice in the future. We reserve the right to make changes and to make the new notice effective for all PHI that we maintain about you, including PHI we created or maintained in the past. If we make material changes to our privacy practices, we will provide you with the revised notice, which we may provide to you in hard copy or electronically, as permitted by applicable law.
This notice is effective September 20, 2013.
This section of the notice explains how Agency uses and discloses your PHI as required or permitted by law. As explained below, in some instances we may request your written authorization to use or disclose PHI.
This section of the notice describes your rights as an individual with respect to your PHI and summarizes how you may exercise these rights.
You may file a complaint in writing with Agency’s Customer Care Department or the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated. Direct your complaints to be filed with Agency to the address provided below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services within 180 days of a violation of your rights. We will not retaliate against you for filing a complaint.
If you have any questions or need further assistance regarding this notice or to request assistance with any of the items listed above, please call our Customer Care Department at (800) 458-5736. The address to send any requests or to file complaints relating to your privacy rights (as described above) is AMA Insurance Agency, Inc., Attn: Customer Care Department, 330 North Wabash Avenue, Suite 39300, Chicago, Illinois 60611-5885.
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or Contact Us online.