STATE HEALTH BENEFITS
SCHOOL EMPLOYEES' HEALTH BENEFITS
The federal Health Insurance Portability
and Accountability Act (HIPAA) requires health plans to maintain
the privacy of any personal information relating to its members'
physical or mental health. The State Health Benefits Program
(SHBP) and the School Employees' Health Benefits Program (SEHBP)
provide the following information, in compliance with HIPAA,
about the safeguarding of your medical information. Scroll
down this page or click on the links below to view the SHBP/SEHBP
Notice of Privacy Practices or to download related forms.
NOTICE OF PRIVACY PRACTICES TO ENROLLEES
STATE HEALTH BENEFITS PROGRAM AND
SCHOOL EMPLOYEES' HEALTH BENEFITS PROGRAM
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.
EFFECTIVE DATE: JANUARY 1, 2016
this Privacy Notice Adobe
Protected Health Information
The State Health Benefits Program (SHBP)
and School Employees" Health Benefits Program (SEHBP) are
required by the federal Health Insurance Portability and Accountability
Act (HIPAA) and State laws to maintain the privacy of any
information that is created or maintained by the Programs
that relates to your past, present, or future physical or
mental health. This Protected Health Information (PHI) includes
information communicated or maintained in any form. Examples
of PHI are your name, address, Social Security number, birth
date, telephone number, fax number, dates of health care service,
diagnosis codes, and procedure codes. PHI is collected by
the Programs through various sources, such as enrollment forms,
employers, health care providers, federal and State agencies,
or third-party vendors.
The Programs are required by law to abide
by the terms of this Notice. The Programs reserve the right
to change the terms of this Notice. If the Programs make material
change to this Notice, a revised Notice will be sent.
Uses and Disclosures of PHI
The Programs are permitted to use and to
disclose PHI in order for our members to obtain payment for
health care services and to conduct the administrative activities
needed to run the Programs without specific member authorization.
Under limited circumstances, we may be able to provide PHI
for the health care operations of providers and health plans.
Specific examples of the ways in which PHI may be used and
disclosed are provided below. This list is illustrative only
and not every use and disclosure in a category is listed.
- The Programs may disclose PHI to a doctor
or a hospital to assist them in providing a member with
- The Programs may use and disclose member
PHI so that our Business Associates may pay claims from
doctors, hospitals, and other providers.
- The Programs receive PHI from employers,
including a member's name, address, Social Security number,
and birth date. This enrollment information is provided
to our Business Associates so that they may provide coverage
for health care benefits to eligible members.
- The Programs and/or our Business Associates
may use and disclose PHI to investigate a complaint or process
an appeal by a member.
- The Programs may provide PHI to a provider,
a health care facility, or a health plan that is not our
Business Associate that contacts us with questions regarding
the member's health care coverage.
- The Programs may use PHI to bill the
member for the appropriate premiums and reconcile billings
we receive from our Business Associates.
- The Programs may use and disclose PHI
for fraud and abuse detection.
- The Programs may allow use of PHI by
our Business Associates to identify and contact our members
for activities relating to improving health or reducing
health care costs, such as information about disease management
programs or about health-related benefits and services or
about treatment alternatives that may be of interest to
- In the event that a member is involved
in a lawsuit or other judicial proceeding, the Programs
may use and disclose PHI in response to a court or administrative
order as provided by law.
- The Programs may use or disclose PHI
to help evaluate the performance of our health plans. Any
such disclosure would include restrictions for any other
use of the information other than for the intended purpose.
- The Programs may use PHI in order to
conduct an analysis of our claims data. This information
may be shared with internal departments such as auditing
or it may be shared with our Business Associates, such as
Except as described above, unless a member
specifically authorizes us to do so, the Programs will provide
access to PHI only to the member, the member's authorized
representative, and those organizations who need the information
to aid the Program in the conduct of its business (our "Business
Associates"). An authorization
PDF (39K) may be obtained over the Internet at: www.state.nj.us/treasury/pensions or by sending an e-mail to: email@example.com A member may revoke an authorization at any time.
- PHI that contains genetic information is prohibited from use or disclosure by the Programs for underwriting purposes.
- The use or disclosure of PHI that includes psychotherapy notes requires authorization from the member.
When using or disclosing PHI, the Programs
will make every reasonable effort to limit the use or disclosure
of that information to the minimum extent necessary to accomplish
the intended purpose. The Programs maintain physical, technical,
and procedural safeguards that comply with federal law regarding
PHI. In the event of a breach of unsecured PHI the member will be notified.
Members of the Programs have the following
rights regarding their PHI:
Right to Inspect and Copy: With
limited exceptions, members have the right to inspect and/or
obtain a copy of their PHI that the Programs maintain in a
designated record set which consists of all documentation
relating to member enrollment and the Program's use of this
PHI for claims resolution. The member must make a request
in writing to obtain access to their PHI. The member may use
the contact information found at the end of this Notice to
obtain a form to request access.
Right to Amend: Members have the
right to request that the Programs amend the PHI that we have
created and that is maintained in our designated record set.
We cannot amend demographic information,
treatment records or any other information created by others.
If members would like to amend any of their demographic information,
please contact your personnel office. To amend treatment records,
a member must contact the treating physician, facility, or
other provider that created and/or maintains these records.
The Programs may deny the member's request
if: 1) we did not create the information requested on the
amendment; 2) the information is not part of the designated
record set maintained by the Programs; 3) the member does
not have access rights to the information; or 4) we believe
the information is accurate and complete. If we deny the member's
request, we will provide a written explanation for the denial
and the member's rights regarding the denial.
Right to an Accounting of Disclosures: Members have the right to receive an accounting of the instances
in which the Programs or our Business Associates have disclosed
member PHI. The accounting will review disclosures made over
the past six years. We will provide the member with the date
on which we made a disclosure, the name of the person or entity
to whom we disclosed the PHI, a description of the information
we disclosed, the reason for the disclosure, and certain other
information. Certain disclosures are exempted from this requirement
(e.g., those made for treatment, payment or health benefits
operation purposes or made in accordance with an authorization)
and will not appear on the accounting.
Right to Request Restrictions: The
member has the right to request that the Programs place restrictions
on the use or disclosure of their PHI for treatment, payment,
or health care operations purposes. The Programs are not required
to agree to any restrictions and in some cases will be prohibited
from agreeing to them. However, if we do agree to a restriction,
our agreement will always be in writing and signed by the
Privacy Officer. The member request for restrictions must
be in writing. A form can be obtained by using the contact
information found at the end of this Notice.
Right to Restrict Disclosure: The member has the right to request that a provider restrict disclosure of PHI to the Programs or Business Associates if the PHI relates to services or a health care item for which the individual has paid the provider in full. If payment involves a flexible spending account or health savings account, the individual cannot restrict disclosure of information necessaryto make the payment but may request that disclosure not be made to another program or health plan.
Right to Receive Notification of a Breach: The member has the right to receive notification in the event that the Programs or a Business Associate discover unauthorized access or release of PHI through a security breach.
Right to Request Confidential Communications: The member has the right to request that the Programs
communicate with them in confidence about their PHI by using
alternative means or an alternative location if the disclosure
of all or part of that information to another person could
endanger them. We will accommodate such a request if it is
reasonable, if the request specifies the alternative means
or locations, and if it continues to permit the Programs to
collect premiums and pay claims under the health plan.
To request changes to confidential communications,
the member must make their request in writing, and must clearly
state that the information could endanger them if it is not
communicated in confidence as they requested.
Right to Receive a Paper Copy of the
Notice: Members are entitled to receive a paper copy of
this Notice. Please contact us using the information at the
end of this Notice or click this link to download
this Privacy Notice. Adobe
Questions and Complaints
If you have questions or concerns, please
contact the Programs using the information listed at the end
of this Notice.
If members think the Programs may have
violated their privacy rights, or they disagree with a decision
made about access to their PHI, in response to a request made
to amend or restrict the use or disclosure of their information,
or to have the Programs communicate with them in confidence
by alternative means or at an alternative location, they must
submit their complaint in writing. To obtain a form for submitting
a complaint, use the contact information found at the end
of this Notice.
Members also may submit a written complaint
to the U.S. Department of Health and Human Services, 200 Independence
Avenue, S.W., Washington, D.C. 20201.
The Programs support member rights to protect
the privacy of PHI. It is your right to file a complaint with
the Programs or with the U.S. Department of Health and Human
HIPAA Privacy Officer
State of New Jersey
Department of the Treasury
Division of Pensions and Benefits
PO Box 295
Trenton, NJ 08625-0295
Forms for SHBP and SEHBP Enrollees
Please be advised that the only
health information available from the Division of Pensions
and Benefits consists of current eligibility, enrollment,
and premium billing information, copies of enrollment applications
and correspondence, and State Health Benefits Commission or
School Employees' Health Benefits Program appeal records. If the information you
are referencing is for a claim, payment of a claim, or medical
records you must contact your medical or dental plan carrier
or the office of your physician or dentist.
Member Authorization Form for
Use and Disclosure of Protected and Private Information
Use this form to authorize
the release of your personal information to providers and
agencies that do not normally conduct business with the SHBP
or SEHBP. Download
Request to Restrict the Release
of Personal Information
Use this form to restrict
to whom the SHBP or SEHBP may release your personal information. Download