Notice of EPIC Program Privacy Practices
(Effective September 23, 2013)
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.
By law, the New York State Elderly Pharmaceutical Insurance Coverage (EPIC) Program is required to protect the privacy of your personal health related information. EPIC is also required to give you a notice to tell you how the program may use and disclose (give out) your personal health related information held by EPIC.
EPIC must use and disclose your personal health related information:
- to you or someone who has the legal right to act for you (your personal representative or caregiver),
- to the Secretary of the federal Department of Health and Human Services, if necessary, to make sure your privacy is protected, and
- where required by law (for example, government oversight and audit).
EPIC has the right, based on your authorization (permission) during enrollment, to use and disclose your personal health related information to pay for your medications and to operate the EPIC Program. For example:
- EPIC may share your personal health related information with EPIC pharmacists to make sure that they are paid for the services they provide to you.
- EPIC may use and disclose your personal health related information to your prescribing physician in the event that your drug regimen is potentially dangerous to your health. For example, if you are taking a combination of drugs that may result in a serious drug interaction or therapeutic duplication, the doctor may change your medication based on this information.
- EPIC may use your personal health related information to make sure you and other EPIC enrollees receive quality health care, to provide customer service to you, or to resolve any complaints you may have.
- EPIC may disclose your personal health related information to other insurance companies to identify any prescriptions billed to the EPIC Program that appear to be the responsibility of the other insurer.
- EPIC may disclose your personal health related information to any other governmental agencies, including Medicare as well as Medicare drug plans that have been authorized as agents by Medicare, that act as a co-payer.
- EPIC may disclose your personal health related information to business partners to operate the EPIC Program. This includes entities that provide assistance and education to EPIC seniors regarding the Medicare Part D drug benefit.
EPIC may use or disclose your personal health related information for the following purposes under limited circumstances:
- For research studies that meet all privacy law requirements.
- To avoid a serious and imminent threat to health or safety, as permitted by law.
- To act as an authorized representative in accordance with the Elder Law, Title 3, Program for Elderly Pharmaceutical Insurance Coverage, Section 242, in pursuing prescription drug coverage under Medicare Part D.
- To contact you about new or changed benefits under EPIC or notify you about other state or federal government benefits that you may be eligible for including but not limited to food stamps, Medicare Savings Program or Energy Assistance Programs.
- To persons involved in your healthcare for the purpose of EPIC's routine program operations, unless you object by contacting us.
By law, EPIC must have your written authorization to use or disclose your personal health related information for any purpose that is not set out in this notice. You may revoke (take back) your written authorization at any time, except if EPIC has already acted based on your authorization.
By law, EPIC is required to notify you following a breach of your unsecured protected health information.
By law, you have the right to:
- See and obtain a copy of your personal health related information held by EPIC.
- Have your personal health related information amended if you believe that it is wrong or if information is missing and EPIC agrees. If EPIC disagrees, you may have a statement of your disagreement added to your personal health related information.
- Obtain a listing of those persons or organizations who receive your personal health related information from EPIC. The listing will not cover health related information that was disclosed to you, information used to pay for your medications, and information used to conduct EPIC routine operations.
- Ask EPIC to communicate with you in a different manner or at a different place (for example, by sending materials to a P.O. Box instead of your home address).
- Ask EPIC to limit how your health related information is used. Please note that EPIC may not be able to agree to your request.
For additional information, forms, to report a problem or file a complaint (if you believe your privacy rights have been violated), you can contact the EPIC Program by calling toll-free at 1-800-332-3742, or by writing to the following address:NYS EPIC Program
PO Box 15018
Albany, NY 12212-5018
Attn: EPIC Privacy Officer
You may also file a complaint with the Office for Civil Rights, US Department of Health and Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3312, New York, New York 10278, telephone number (212) 264-3313, fax number (212) 264-3039, TDD (212) 264-2355. You will not be penalized for filing a complaint or assisting an investigation.
By law, EPIC is required to follow the terms in this notice. EPIC has the right to change the way your personal health related information is used and disclosed. If EPIC makes any changes, you will receive a new notice by mail within 60 days of the change.