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Privacy Statement

Health Care Privacy Compliance Statement

The following information describes how we protect the confidentiality of the health information you, your employer, administrator, insurance carrier, or business associates furnish us about your personal health information.

NOTICE OF PRIVACY PRACTICES

CONFIDENTIALITY OF YOUR HEALTH CARE INFORMATION

This notice is required by federal law to tell you how Vantage Flex and its related companies, or those entities we receive information from, protect the confidentiality of your health care information in our possession.

Protected Health Information (PHI) is defined as any individually identifiable information regarding a patient's medical or dental history; mental or physical condition; or treatment. Some examples of PHI include your name, address, telephone and/or fax number, electronic mail address, social security number or other identification number, date of birth, date of treatment, treatment records, x-rays, enrollment and claims records. Vantage Flex receives uses and discloses your PHI to administer your benefit plan or as permitted or required to by law. Any other disclosure of your PHI without your authorization is prohibited.

We must follow the privacy rules that are described in this notice, but also comply with any stricter requirements under state law that may apply to Vantage Flex's administration of your benefits. However, we may change this notice and make the new notice effective for all of your PHI that we maintain. If we make any substantive changes to our privacy practices, we will promptly change this notice and redistribute to you within 60 days of the change to our practices. You may also request a copy of this notice every three years.

Permitted Uses and Disclosures of your PHI

We are permitted to use or disclose your PHI without your prior authorization for the purposes outlined herein. The permitted uses and/or disclosures are for the purposes of health care treatment, payment of claims, billing of premiums, and other health care operations. If your employer or another party sponsors your benefit program, we may provide PHI to your employer or that sponsor for purposes of administering your benefits. These affiliates have also implemented privacy policies and procedures and comply with applicable federal and state law.

We are also permitted to use and/or disclose your PHI to comply with a valid authorization, to assist in notifying a family member, another person, or a personal representative of your condition, to assist in disaster relief efforts, and to report victims or abuse, neglect, or domestic violence.

Other permitted uses and/or disclosures are for the purposes of health oversight by government agencies; judicial, administrative, or other law enforcement purposes; information about decedents to coroners, medical examiners and funeral directors; for research purposes; for organ donation purposes; to avert a serious threat to health or safety; for specialized government functions such as military and veterans activities; for workers compensation purposes; and for use in creating summary information that can no longer be traced to you.

Additionally, with certain restrictions, we are permitted to use and/or disclose your PHI for fundraising and underwriting. We are also permitted to incidentally use and/or disclose your PHI during the course of a permitted use and/or disclose, but we must attempt to keep incidental uses and/or disclosures to a minimum. We use administrative, technical and physical safeguards to maintain the privacy of your PHI, and we must limit the use and/or disclosure of your PHI to the minimum amount necessary to accomplish the purpose of the use and/or disclosure.

EXAMPLES OF USES AND DISCLOSURES OF YOUR PHI FOR TREATMENT, PAYMENT, OR HEALTH CARE OPERATIONS

Such activities may include but are not limited to: processing your claims, collecting enrollment information and premiums, reviewing the quality of health care you receive, providing customer service, resolving your grievances, and sharing payment information with other insurers or administrators.

DISCLOSURES VANTAGE FLEX MUST MAKE WITHOUT AN AUTHORIZATION.

We are required to disclose your PHI to you and your authorized personal representative (with certain exceptions), when required by the U.S. Secretary of Health and Human Services to investigate or determine our compliance with the law, and when otherwise required by law. Vantage Flex must disclose your PHI without your prior authorization in response to the following: Court order; Order of a board, commission, or agency for purposes of adjudication pursuant to its lawful authority; Subpoena in a civil action; Investigative subpoena of a government board, commission, or agency; Subpoena in an arbitration, Law enforcement search warrant; or coroner's request during investigations.

DISCLOSURES VANTAGE FLEX MAKES WITH YOUR AUTHORIZATION

Vantage Flex will not use or disclose your PHI without prior authorization if the law requires your authorization. You can later revoke that authorization in writing to stop any future use and disclosure. The authorization will be obtained from you by your Employer or by a person requesting your PHI from Vantage Flex.

YOUR RIGHTS REGARDING PHI

YOU HAVE THE RIGHT TO REQUEST AN INSPECTION OF AND OBTAIN A COPY OF YOUR PHI (in Vantage Flex's case, your claims, reimbursement schedule, transaction details, etc.)

You may access your PHI by contacting:
Vantage Flex, LLC | 2012 10th Street | Menominee, MI 49858 -OR- 906-863-3539

You MUST include (1) your name, address, telephone number, and identification number; AND (2) the PHI you are requesting. Vantage Flex may charge a reasonable fee for providing you copies of your PHI. Vantage Flex will only maintain PHI that we obtain or utilize in providing your health care benefits. You may need to contact your health or dental care provider to obtain PHI that Vantage Flex does not possess. You may not inspect or copy PHI compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, or PHI that is otherwise not subject to disclosure under federal or state law. In some circumstances, you may have a right to have this decision reviewed. Please contact Vantage Flex or your employer if you have questions about access to your PHI.

YOU HAVE THE RIGHT TO REQUEST A RESTRICTION OF YOUR PHI.

You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.

YOU HAVE THE RIGHT TO CORRECT OR UPDATE PHI

This means that you may request an amendment of PHI about you for as long as we maintain this information. In certain cases we may deny your request for an amendment. If we deny your request for an amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. If another sent your PHI to us, we may refer you to that person to amend your PHI. For example, we may refer you to your doctor or dentist to amend your treatment chart or to your employer, if applicable, to amend your enrollment information.

YOU HAVE THE RIGHT TO REQUEST OR RECEIVE CONFIDENTIAL COMMUNICATIONS FROM US BY ALTERNATIVE MEANS OR AT A DIFFERENT ADDRESS.

We will agree to a reasonable request if you tell us that disclosure of your PHI could endanger you. You may be required to provide us with a statement of possible danger, a different address, another method of contact or information as to how payment will be handled.

YOU HAVE THE RIGHT TO GET THIS NOTICE BY E-MAIL.

Even if you agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice.

COMPLAINTS:
You may complain to us or to the U.S. Secretary of Health and Human Services if you believe that Vantage Flex has violated your privacy rights. We will not retaliate against you for filing a complaint.

CONTACT:
You may contact the Privacy Department at:

Vantage Flex, LLC
2012 10th Street
Menominee, MI 49858

EFFECTIVE DATE:
This notice became effective on and after April 14, 2003

FSA Eligible Expenses and Items