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Notice of Privacy Practices - For your Personal Health and Financial Information

CarePlus has worked diligently to comply with privacy provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), a federal law designed to ensure the privacy of personal and health information. In addition to all federal laws, CarePlus also complies with all state laws and regulations.

Below, you will find the Privacy Protection Policy both in English and Spanish. You should review the documents to get a thorough understanding of how CarePlus uses and discloses personal health information.

Individual Rights Forms

The following is a brief description of the various HIPAA individual rights and the appropriate form to invoke one of these rights.

Consent for Release of Protected Health Information

This form grants CarePlus permission to share your information to a trusted individual(s) that you choose. The form below allows you to choose the level of information to share with the trusted individual. You can specify any and all information, information specific to a treatment or injury, or something different. This form was last updated in January 2016.

PDFEnglish (link opens in new window)  | PDFSpanish (link opens in new window) 

Revocation of Consent for Release of Protected Health Information

This form terminates previously granted permission for CarePlus to release or disclose a member's protected health information to other individuals named on the form. This form was last updated in October 2016.

PDFEnglish (link opens in new window)  | PDFSpanish (link opens in new window) 

Request for Accounting of Disclosures

This form requests a list of disclosures CarePlus made of a member's protected health information. Disclosures made for payment and health plan operations are excluded from this process. The form was last updated in October 2016.

PDFEnglish (link opens in new window)  | PDFSpanish (link opens in new window) 

Request Amendment to your Protected Health Information

This form requests a correction to CarePlus-created protected health information that a member feels is inaccurate or incomplete. This form was last updated in October 2016.

PDFEnglish (link opens in new window)  | PDFSpanish (link opens in new window) 

Request to Access Protected Health Information

This form requests an inspection or copy of CarePlus-maintained protected health information about a member. This form was last updated in October 2016.

PDFEnglish (link opens in new window)  | PDFSpanish (link opens in new window) 

Request for Restriction of Protected Health Information

This form requests limitation or restriction of disclosures of a member's protected health information to others such as a family member, friend, spouse, doctor, or any other party. This form was last updated in October 2016.

PDFEnglish (link opens in new window)  | PDFSpanish (link opens in new window) 

Request for Termination of Restriction

This form withdraws a previously requested restriction of a member's protected health information. The form was last updated in October 2016.

PDFEnglish (link opens in new window)  | PDFSpanish (link opens in new window) 

Request for Alternate Communications

This form requests that CarePlus communicate with a member about protected health information in a different way during life-threatening situations. Examples of alternate means could include telephone, mail, e-mail, or different address. The form was last updated in October 2016.

PDFEnglish (link opens in new window)  | PDFSpanish (link opens in new window) 

HIPAA Privacy Complaint Form

This form documents an issue or concern if a member believes his or her privacy rights may have been violated. This form was last updated in October 2016.

PDFEnglish (link opens in new window)  | PDFSpanish (link opens in new window) 

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