Privacy and Disclosures

PLEASE READ THE FOLLOWING IMPORTANT DISCLOSURE NOTICES.

NOTICE OF PRIVACY PRACTICES (Aviso de practices de privacidad*)

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.

You may ask for an additional paper copy of this privacy notice at any time.

Para recibir esta noticia en español llame al 800-346-4643. >TTY 800-704-6370.*

In this notice, the words “us”,"our" and “we” mean Rocky Mountain Health Plans or RMHP. This includes plans underwritten by Rocky Mountain HMO, Inc. and Rocky Mountain HealthCare Options, Inc.

Q. Why is this notice provided?

A. Rocky Mountain Health Plans respects the privacy of your personal health information, also called PHI. By law, we have to make sure that your PHI is kept private. We must also give you this notice of our legal duties, your rights, and our privacy practices about your PHI. We must tell you about how and when we may use, share, or discuss your PHI with others.

Q. What is PHI?

A. PHI includes information that we have about your past, present, or future health or medical condition that could be used to identify you. It includes such things as health care treatment, or payment for health care you have received.

Q. How and when can you use, give out, or tell others about my PHI?

A. RMHP can use or give out your PHI:

  • To help make sure your medical bills sent to us for payment are handled the right way.
  • To help your doctors or other health care providers manage your health care, such as if you're in a wellness program or if you are a home health patient.
  • To send you a reminder if you have a doctor's visit.
  • To give you information about other health care treatments, services, and programs you may be interested in, such as a weight-loss program.
  • To tell an employer that helps pay for your health benefits of your enrollment with RMHP.  Any PHI we might give to your employer group plan sponsor cannot be used for employment or benefit decisions.
  • With other people who are with you at the time we discuss your PHI.  For example, when you allow others to be in the room when a home health nurse visits your home or if your spouse is with you on the phone when you call us. In these cases we may talk about your PHI with both of you.
  • If you are injured or unconscious we may share PHI with your family or friends to help make sure you get the care you need and talk about how the care will be paid for.

Please note: We will not use your PHI that is genetic information for any underwriting purposes.

 

Q. Are there state or federal laws that may call for RMHP to share your PHI?

A. Yes, there are also state and federal laws that may call for us to give your PHI to others. For example, we may give out your PHI: 

  • To state and federal agencies that regulate us, such as the U.S. Department of Health and Human Services and the Colorado Division of Insurance.
  • For public health activities. This may include reporting disease outbreaks.
  • To public health agencies if we think there is a serious health or safety threat.
  • For government health oversight activities, such as fraud investigations.
  • To a court or administrative agency, such as to obey a court order.
  • For law enforcement purposes, such as to find a suspect.
  • To a government authority when there is abuse, neglect, or violence in the home.
  • To a coroner, medical examiner, or funeral director to aid in deciding cause of death.
  • For getting, saving, or transplanting organs, eyes, or tissue, and also in limited ways for research activities.
  • For special government functions, such as for national safety.
  • For job-related injuries because of state worker compensation laws.

If none of the above reasons apply, we must ask you to tell us in writing that we may use or give out your PHI before we do it.

 

Q. Are there other reasons you can use, share, or tell others about my PHI?

A. No, except for the situations listed above, we will not use or disclose your PHI for any other reason unless we have your written permission. If you tell us in writing that we may use or give out your PHI and change your mind, you may take back your written permission at any time. But you cannot take back your written permission if we already acted when we had your permission. Most uses and disclosures of psychotherapy notes, and uses and disclosures of PHI for marketing reasons or that are tied to a “sale” of PHI can only happen with your written permission.

Q. What are my rights with respect to my PHI?

You have the right to ask that we limit how we use and give out your PHI. You also have the right to ask us to limit how much PHI we give to someone who is involved in your care or helping pay for your care. Please note that we do not have to agree to the request.

You have the right to ask that we talk with or write to you in a different way or at a different place to protect you from danger. For example, you may ask us to send your PHI to your work address instead of your home address.

You have the right to see and ask for a copy of your PHI. You can ask to have your PHI given to you in a particular way or form, such as paper or electronic format. We will try to meet your request if it is not too difficult to provide it in that format. You may also ask that we describe and tell you in writing about the PHI we have about you. We will respond to you within 30 days after we get your written request. If we deny your request, we will write back to you with the reasons. We will also explain your right to have our denial reviewed. We may charge you a reasonable fee based on the copy costs for labor and supplies to meet your request or for writing a description of PHI if that is what you asked for.

You have the right to get a list of times in which we have given out your PHI during the six years before your request. Please note that we are not required to give you a list of every time we gave out your PHI.

We do not have to tell you the times we gave out your PHI:

  • Before April 14, 2003.
  • For treatment, payment, and health care operation purposes.
  • To you or others, if we have your written permission.
  • To persons involved in your care or payment for care.
  • For national safety reasons, or in special situations required by law enforcement or health oversight agencies.

We will act on your request within 60 days. Your first list will be free. We will give you one free list every 12 months if you ask for it. If you ask for another list within 12 months of getting your free list, we may charge you a fee.

You have the right to ask us to change your PHI or add missing information if you think there is a mistake in your PHI. We will respond within 60 days of getting your written request. If we deny your request, we will tell you the reasons in writing. Our written denial will also explain your right to file a written statement of disagreement. You can ask us to attach your request, our denial, and your statement of disagreement to your PHI anytime we give it out in the future.

Q. If I want to use these rights, do I have to make a written request?

A. Yes. All requests must be made in writing. You do not have to use any special form, but you can get a request form by calling our Customer Service line at 970-243-7050 or 800-346-4643. Send in your request to: Rocky Mountain Health Plans, PO Box 10600, Grand Junction, CO 81502-5600.

Q. How may I complain about RMHP's privacy practices?

A. Send your written complaint to RMHP Customer Service, Attn: Privacy, PO Box 10600, Grand Junction, CO 81502-5600. You also may complain to the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint about our privacy practices or for using any of the rights described in this notice.

Q. What other steps do we take to protect you PHI?

A. We limit access to your PHI to those who need it in order to help us provide products or services to you.  Other policies, such as limiting access to facilities, only discussing PHI in secure areas, keeping fax machines in secure areas, requiring passwords for computer access, and checking your identity before we discuss your PHI also help to protect your information. If there is a breach of your unsecured PHI, you have the right to be notified of the breach and we will provide notice to you in writing.

Q. How will I know if my rights described in this notice change?

A. We follow the terms of the notice that is now in effect. This notice is effective as of September 23, 2013. We reserve the right to change the terms of this notice and our privacy policies at any time. Then the new notice will apply to all your PHI. If we change this notice, we will put the new notice on our website and mail a copy of the new notice to our subscribers with the next regular annual mailing after the new notice takes effect.

Q. Who should I contact to get more information, or to get a copy of this notice?

A. You can do this in one of three ways: 

  • Visit our website: www.rmhp.org.
  • Write to us: Rocky Mountain Health Plans, PO Box 10600, Grand Junction, CO 81502-5600.
  • Call Rocky Mountain Customer Service: 970-243-7050 or 800-346-4643.

 

DISCLOSURE NOTICE FOR SMALL EMPLOYER GROUPS 

Class of Business

Your group will be included in the Small Employer class and will not be considered part of a separate class of business.  This class is comprised of small employer groups with up to 50 eligible employees and includes qualified Business Groups of One. 

Rates

The total premium for small employer groups will be determined by summing the total premium of each enrolled employee.  The total premium for each enrolled employee will be determined by summing the separate premiums of the employee and their dependents for the health plan the employee has selected.  Premiums will be summed up for the employee, spouse, dependent children between the ages of 21 and 26, and the three oldest dependents under 21.

The premium for each specific employee and family member will be based on the age of each person as of the group's effective date.  Factors that may affect changes in premium rates include tobacco use, plan design and the addition/deletion of employees and/or dependents.  Dependent children are eligible for coverage to age 26.

Rates will be based on the county where the employer has its main place of business.  "RMHP reserves the right to change premium rates.  Periodic rate changes, which must be approved by the Colorado Division of Insurance, are implemented to ensure that the premium collected by RMHP is sufficient to pay the medical claims incurred by RMHP members.  Rate changes can occur annually at the time of a group's renewal."

To make premiums uniform for their employees, employers may choose to create their own "composite" rate based on the total group premium and the number of employees covered.  Please ask your broker or RMHP Representative for information on composite rates.

Access Plans

An access plan is available upon request to any interested party for each managed care network offered by RMHP.  Such access plans contain information on providers, hospitals, referral and grievance procedures, quality assurance, access for members with special needs, emergency coverage provisions, and other information on how to access services.

Geographic Areas Served

Upon request, we will provide you or any enrollee a description of the geographic areas served by Rocky Mountain Health Plans.

Benefits and Premiums

Information about benefits for all the health benefit plans you requested or for which you qualify is enclosed.  If you have provided us sufficient information to determine premiums for your group, such premium information is also included.  Colorado law requires carriers to make available a Colorado Supplement to the Summary of Benefits of Coverage, which is intended to facilitate comparison of health plans.  The form must be provided automatically within seven (7) business days to a potential policyholder who has expressed interest in a particular plan or who has selected the plan as a finalist from which the ultimate selection will be made.  The carrier also must provide the form, upon oral or written request, within (7) business days to any person who is interested in coverage under or who is covered by a health benefit plan of the carrier.

Patient Protection and Affordable Care Act Group Notices for Rocky Mountain Health Plans ("Your Plan")

Your Plan may require the designation of a primary care provider (PCP).  A Member has the right to designate any PCP who participates in RMHP's network and who is available to accept the Member as a Patient.  If required, until a Member makes this designation, a PCP will be designated for the Member.  For information on how to select a PCP,  and for a list of the participation PCPs, contact customer service at 970-243-7050 or 800-346-4643.  For children, a pediatrician may be designated as the PCP.  A Member does not need prior authorization in order to obtain access to obstetrical or gynecological care from a health care professional in RMHP's network who specializes in obstetrics or gynecology.  The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals.  For a list of participating health care professionals who specialize in obstetrics or gynecology, contact customer service at 970-243-7050 or 800-346-4643.

Your Group's Right to Renew

Your group may renew its coverage for successive one-year periods. Your group may terminate the agreement by giving RMHP written notice of intent to terminate.  RMHP must receive such written notice no later than 5:00 P.M. Mountain Time on the first business day of the month following the termination effective date; otherwise, the effective date of termination shall be the end of the next calendar month.

RMHP shall not discontinue coverage or refuse to renew a plan except for the following reasons:

  • Nonpayment of required premiums.
  • Fraud or intentional misrepresentation of material fact by the group or with respect to coverage of an individual or fraud or intentional misrepresentation of material fact by the individual or the individual’s representative.
  • RMHP elects to nonrenew and discontinue offering all its small group health care plans delivered or issued in the State of Colorado
  • The group fails to comply with participation or contribution requirements.
  • There is no longer any member who is a group enrollee who lives, resides, or works in the service area.
  • The group is no longer actively engaged in the business in which it was engaged on the effective date of the Group Service Agreement.
  • An employer that is provided coverage through one or more bona fide associations ceases to belong to that association(s).
  • Any other reason for which state or federal law permits nonrenewal of the Group Service Agreement.

COLORADO INSURANCE LAW REQUIRES ALL CARRIERS IN THE SMALL GROUP MARKET TO ISSUE ANY HEALTH BENEFIT PLAN IT MARKETS IN COLORADO TO SMALL EMPLOYERS UP TO 50 EMPLOYEES REGARDLESS OF THE HEALTH STATUS OF ANY OF THE INDIVIDUALS IN THE GROUP.

The disclosure statements in this form are required by Colorado law and are not intended to be a full description of all plan requirements. The complete provisions of the plan(s), including detailed description of benefits, exclusions, and limitations, can be found in the Group Service Agreement and the Evidence of Coverage.

MK661 - Revised 2013

Click here for a printable version of this disclosure.

 

DISCLOSURE NOTICE FOR LARGE EMPLOYER GROUPS

Access Plans

An access plan is available upon request to any interested party for each managed care network offered by RMHP. Such access plans contain information on providers, hospitals, referral and grievance procedures, quality assurance, access for members with special needs, emergency coverage provisions, and other information on how to access services.

Geographic Areas Served

Upon request, we will provide you or any enrollee a description of the geographic areas served by Rocky Mountain Health Plans.

Your Group’s Right to Renew

Your group may renew its coverage for successive one-year periods. Your group may terminate the agreement by giving RMHP written notice of intent to terminate. RMHP must receive such written notice no later than 5:00 p.m. Mountain Time on the first business day of the month following the termination effective date; otherwise, the effective date of termination shall be the end of the next calendar month.

Colorado law requires carriers to make available a Colorado Health Plan Description Form, which is intended to facilitate comparison of health plans. The form must be provided automatically within three (3) business days to a potential policyholder who has expressed interest in a particular plan or who has selected the plan as a finalist from which the ultimate selection will be made. The carrier also must provide the form, upon oral or written request, within three (3) business days to any person who is interested in coverage under or who is covered by a health benefit plan of the carrier.

The disclosure statements on this form are required by Colorado law and are not intended to be a full description of all plan requirements. The complete provisions of the plan(s), including detailed description of benefits, exclusions, and limitations, can be found in the Group Service Agreement and the Health Benefits Contract.

MK298 - Revised March, 2009

Click here for a printable version of this disclosure.

EQUAL OPPORTUNITY POLICY STATEMENT

This policy is available on tape in Human Resources.

It is the policy of Rocky Mountain Health Plans (RMHP) to provide equal opportunity and to prevent discrimination based on race, color, national origin, age, or disability in admission or access to, or treatment or employment in, RMHP programs, health care plans, and activities to the extent required by applicable law.

All federally funded benefits and services are provided in accordance with Title VI of the Civil Rights Act, as amended, Section 504 of the Rehabilitation Act, as amended, the Age Discrimination Act of 1975, as amended, the Americans with Disabilities Act of 1990, as amended, as well as other related laws. All subcontractors are notified of their responsibility to comply with these laws.

The EEO Officer is responsible for compliance with state and federal equal opportunity laws. The EEO Officer is also responsible for implementing the Equal Opportunity Plan. If you would like more information regarding these provisions, or if you believe you have not been treated in accordance with this policy, please contact the Member Concerns Coordinator at 800-346-4643, 970-243-7050, or TTY 800-704-6370 or 970-248-5019; para asistencia en español llame al 800-346-4643.

 

MEDICARE DISCLAIMERS

What Information Do We Collect?

Automatic Collection of Information:

If you do nothing during your visit but browse through the website or download information, our system will automatically gather and store certain information about your visit. This information does not identify you personally and is used in an aggregate way to help us improve our website usability and tell us how many people visit our site over a period of time.

Our Web server automatically collects and records the following information:

  • Aggregate information on what pages are accessed.
  • The name and release number of web browser software used.
  • The operating system used.
  • Date and time of access.
  • The address of the web site that linked to us (referrer URL).
  • Time spent on the page.

How Do We Use the Information We Collect?

The information we gather automatically and with your permission during your visit to our web site is used to:

  • Monitor, review, measure, and analyze web site utilization.
  • Modify and enhance the web site.
  • Improve the content and design of our web site.
  • Monitor and improve our customer experience efforts.
  • Notify visitors about updates to our web site.