About Your Privacy
These regulations affect some of your dealings with the Fund Office. We recognize that the requirements of the Privacy Rules may be an inconvenience to you. However, the Fund Office and the Fund Trustees are doing everything possible to minimize the burden on you.
The U.S. Department of Health & Human Services, which issued the Privacy Rules, has a website which discusses the Privacy Rules and answers a number of questions at www.hhs.gov/ocr/hipaa/privacy.html.
Frequently Asked Questions
What do the regulations require?
In general, the regulations require the Fund to secure all medical information about you and your dependents so that it is not readily accessible or available to those who do not need access to it. Of course, we can share information with health providers for billing and payment and our staff and advisors will have access to some information to carry out this responsibility. However, we will no longer be able to discuss or disclose your information with other persons, such as your spouse or your union officials, unless you specifically authorize the Fund to do so. If you call about your spouse, or your spouse calls about you, we cannot disclose information without an authorization.
(There is an exception in the Rules allowing parents to obtain information from us concerning their minor children).
If your Business Agent calls about you or any family member, we cannot disclose the information without an authorization. It does not matter that your spouse or Business Agent may already know all the details directly from you.
Protected Health Information or "PHI" is any information that relates to the past, present or future physical or mental health or condition of any individual that explicitly identifies the individual or is detailed and specific enough that the identity of the individual can reasonably be determined. For example, PHI includes the individual's name, address, phone number, fax number, e-mail address, Social Security number, marital status, eligibility for benefits, local union number, medical diagnosis, types or dates of treatment or service. Therefore, an individual's benefit information, claims records and benefit appeals would all include PHI and the use and disclosure of this information would have to be restricted.
Certain types of individually identifiable medical information are not PHI. For instance, medical information that is generated by employers for employment-related purposes, but is not sent to the Plan is not PHI. This information might include medical information not created or maintained by the Plan, such as that gathered from pre-employment physicals, reports of on-the-job injuries, or information submitted in support of Family and Medical Leave Act requests for leave, or requests for reasonable accommodation under the Americans With Disability Act.
How can I get PHI about myself from the Fund Office?
Generally, the Fund Office will disclose PHI directly to you or your Personal Representative, for inspection or copying, upon reasonable request and after completion of either a properly completed "Request for Protected Health Information Form" ("Request Form") or some written request acceptable to the Fund.
You need only make a verbal request for copies of you or your minor dependents explanations of benefits. You may also obtain a copy of your work history without a formal written request.
If you request PHI about yourself over the phone, by fax or by mail, the Fund Office will verify your identity before providing you with PHI.
How do I authorize my spouse or Business Agent to assist me in dealing with the Fund Office?
If you are not present, your spouse or another person Business Agent cannot get specific information from the Fund Office about you unless you first submit a written authorization to the Fund Office. We strongly encourage you to take a moment right now and fill out an Authorization Form so that the Fund Office will have it on file. You may send the completed form to the Fund Office by mail or facsimile at (213) 383-0725.
How can I assist my spouse and other dependents in dealing with the Fund Office?
Generally, the Fund Office can only disclose your spouse's PHI to you if a completed, valid Authorization Form is on file.
As a parent or legal guardian, you are entitled to access the PHI of your minor dependents upon receipt by the Fund of a Request Form executed by you, or other acceptable written request you provide, if (i) the dependent is less than 18 years of age; (ii) the dependent is not an "emancipated minor"; and (iii) the PHI sought does not refer or relate to treatment for or advice about conditions that would under applicable state law permit the dependent minor to be treated as an adult.
Can PHI ever be disclosed by the Fund Office without an Authorization Form?
In the absence of an Authorization Form, the Fund Office may disclose to a family member, other relative, close personal friend, union official, or any other person identified by the protected individual, the PHI directly relevant to such person's involvement with the individual's health care if the individual whose PHI is protected: (i) is present at the time of disclosure; (ii) has the capacity to make health care decisions; and (iii) consents in advance to the Fund Administrator's disclosure of PHI.
Additionally, the Fund Administrator may disclose PHI to an individual's family member, other relative or close personal friend, or any other person, if, in the absence of an Authorization Form, the individual whose information is protected if: (i) the individual is not present, or the opportunity to agree or object to the use or disclosure cannot practicably be provided because of the individual's incapacity or an emergency circumstance; (ii) the Fund Administrator determines, in the exercise of professional judgment, that the disclosure is in the best interests of the individual; and (iii) only the PHI that is directly relevant to the person's involvement with the individual's health care is disclosed.
Southern California Pipe Trades Administrative Corporation | 501 Shatto Place, 5th Floor | Los Angeles | CA 90020 | (800) 595-7473 | Press Option "2" for Member Services | Outside US (213) 385-6161 | Fax (213) 383-0725