Welcome to the MyBenefitsChannel.com web site (as it currently exists or is subsequently modified, this “Site”). This Site is offered to you by Five Points ICT, Inc. (“Five Points”) conditioned on your acceptance, without modification, of the terms, conditions, policies and notices contained on this page (these “Terms of Use”).

Important Note:  The contents of this site are for informational purposes only and are thus not intended as a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this site.  This site is not intended to provide instructions in the event of an emergency.  If you think you may have a medical emergency, call your doctor or 911 immediately. We do not recommend or endorse any specific tests, physicians, products, procedures, opinions or other information that may be mentioned on this site. Reliance on any information provided on this site is solely at your own risk.  You understand and agree that some health improvement activities are not appropriate for individuals who have certain medical or other health conditions. You are responsible for seeking medical advice from a physician prior to participating in any health improvement activity discussed in MyBenefitsChannel.com.  You hereby agree and understand that you may not be aware of a medical condition from which you suffer, and therefore you should not participate.

1.    Acceptance of Contract Terms

Please read these Terms of Use carefully before using this Site. If you do not agree to all of the notices, terms and conditions contained in these Terms of Use, do not use this Site. By accessing and using this Site in any way, including without limitation, browsing this Site, using any information, using any content, using any services, downloading any materials, and/or placing an order for products or services, you acknowledge that you have read, understood, and agree to be bound by these Terms of Use, including but not limited to conducting this transaction electronically, disclaimers of warranties, damage and remedy exclusions and limitations, and a choice of Tennessee law.

2.    Copyright and Trademark Notices

As long as you comply with these Terms of Use and any modifications thereto, Five Points grants you a personal, non-exclusive, non-transferable, non-sublicensable, limited right to enter and use the Site. All contents of this Site are: ©2009-2013 MyBenefitsChannel.com.  All rights reserved. This Site contains copyrighted material, trademarks and other proprietary information including without limitation, text, software, photographs, graphics, and/or sound, and the entire contents of this Site are copyrighted as a collective work under the United States copyright laws.  Five Points owns a copyright in the selection, coordination, arrangement, enhancement and “look and feel” of this Site.  You may not modify, publish, transmit, participate in the transfer or sale, create derivative works, or in any way exploit any of the content contained on this Site without the express written permission of Five Points.  You acknowledge that Five Points and/or third-party content providers remain the owners of all materials, service marks and trademarks posted on this Site, and that you do not acquire any of those ownership or license rights therein.  The following is a list of trademarks currently used and owned by Five Points ICT, Inc.: My Benefits Channel, and My eHealth Clinic.  Five Points trademarks may be used only with prior written permission from Five Points. The use of our trademarks or names in metatag keywords is trademark infringement, and the use of trademarks or names in page text, metatags, and/or hidden text for purposes of gaining higher rankings from search engines is unfair competition. Framing, inline linking or other association of this Site or Five Points with links, advertisements and/or other information not originating from Five Points is expressly prohibited. Third party trademarks, trade names, logos, product or service names contained on this Site may be the trademarks, registered or unregistered, of their respective owners.

3.    Five Points Accounts

(a)  User Membership.  As part of the member registration process, you must complete the registration process by providing us with current, complete and accurate information as prompted by the applicable registration form.  Access to the Services is enabled only by login names and passwords. You will create a password and login. You are entirely responsible for maintaining the confidentiality of your password and account during the registration process. Five Points will not be liable for any loss that you may incur as a result of someone else using your login, password or account, either with or without your knowledge. However, you could be held liable for losses incurred by Five Points or another party due to someone else using your account or password. You may not use anyone else’s account at any time, without the permission of the account holder. Failure to comply with the foregoing shall constitute a breach of these Terms of Use, which may result in immediate termination of your account.

(b)  User Responsibility for Account Use. You may NOT share your password or account with others or to any third party. Corporate visitors must have one account for each participating employee; employees may not share accounts. You shall notify Five Points at websecurity@FivePointsICT.com of any known or suspected unauthorized use(s) of your account, or any known or suspected breach of security, including but not limited to loss, theft or unauthorized disclosure of your password. You are responsible for all usage or activity on your Five Points.com account. Any fraudulent, abusive or otherwise illegal activity may be grounds for termination of your account, at Five Points’ sole discretion, and Five Points may refer you to appropriate law enforcement agencies.

(c)  Account Termination.  Five Points may, in its sole discretion, terminate or suspend your access to all or part of this Site and any services offered through this Site for any reason, including, without limitation, breach or any purported assignment of these Terms of Use, lack of use, or if Five Points believes that you have violated or acted inconsistently with the letter or spirit of these Terms of Use. Further, you agree that Five Points shall not be liable to you or any third-party for any termination of your access to this Site or your account.

(d)  Account Security.  Your Personal Information will be stored in a secure manner. We have implemented a variety of commercially standard encryption and security technologies and procedures to protect your Personal Information stored in our computer systems from unauthorized access. We also maintain standard physical and electronic procedural safeguards that limit access to your Personal Information to our employees (or people working on our behalf and under confidentiality agreements) who, through the course of standard business activities, need to access your Personal Information.

You should maintain your login code and password in strict confidence. In no event should you share your login code or password with any third party or allow another person to access the Services using your login code and password unless you are willing to have that person see all of your Personal Information. You must notify us if you have any reason to believe that your login code or password has been lost or compromised or misused in any way. You are fully and solely responsible for any and all use of the Services using your login code and password. We reserve the right to revoke or deactivate your login code and password at any time.

Please be aware that the email address that is associated with your account may receive personal and/or private health information relating to the Services, and you should strongly consider using an email address to which only you have access.

4.    Disclaimer

YOUR USE AND BROWSING OF THIS SITE IS AT YOUR RISK. FIVE POINTS MAKES NO GUARANTEE OF AVAILABILITY OF THIS SITE OR ANY SERVICES OFFERED THROUGH THIS SITE. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, EVERYTHING ON THE SITE IS PROVIDED TO YOU “AS IS, WHERE IS” AND “AS AVAILABLE”, WITHOUT WARRANTY OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING, WITHOUT LIMITATION, ANY WARRANTY FOR INFORMATION, DATA, OR UNINTERRUPTED ACCESS, ANY WARRANTIES CONCERNING THE AVAILABILITY, ACCURACY, USEFULNESS, OR CONTENT OF INFORMATION, AND ANY WARRANTIES OF TITLE, NON-INFRINGEMENT, MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.  FIVE POINTS DOES NOT WARRANT THAT THIS SITE OR THE CONTENT CONTAINED HEREIN WILL BE TIMELY, SECURE, UNINTERRUPTED OR ERROR FREE, OR THAT ANY DEFECTS WILL BE CORRECTED, NOR IS ANY RESPONSIBILITY ASSUMED FOR INCORRECT OR INACCURATE CAPTURE OF INFORMATION, INCLUDING BUT NOT LIMITED TO MALFUNCTIONS, HUMAN ERROR, LOST/DELAYED/GARBLED DATA OR TRANSMISSIONS, OMISSION, INTERRUPTION, DELETION, DEFECT, FAILURES OF ANY COMMUNICATIONS, EQUIPMENT, SOFTWARE OR ANY COMBINATION THEREOF.  FIVE POINTS MAKES NO WARRANTY THAT THIS SITE WILL MEET ANY USER’S REQUIREMENTS.  NO ADVICE, RESULTS OR INFORMATION, WHETHER ORAL OR WRITTEN, OBTAINED BY YOU THROUGH THIS SITE SHALL CREATE ANY WARRANTY NOT EXPRESSLY MADE HEREIN.  IF YOU ARE DISSATISFIED WITH THIS SITE OR ANY CONTENT OR FUNCTION THEREON, YOUR SOLE REMEDY IS TO DISCONTINUE USING THIS SITE.

5.    Limitation of Liability

IN NO EVENT SHALL FIVE POINTS OR ANY OF ITS DIRECTORS, OFFICERS, EMPLOYEES, AGENTS, AFFILIATES, SPONSORS OR CONTENT OR SERVICE PROVIDERS BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, EXEMPLARY OR PUNITIVE DAMAGES ARISING FROM OR DIRECTLY OR INDIRECTLY RELATED TO THE USE OF, OR THE INABILITY TO USE, THIS SITE OR ANY CONTENT, MATERIALS OR FUNCTIONS RELATED THERETO, INCLUDING WITHOUT LIMITATION, LOSS OF REVENUE, OR ANTICIPATED PROFITS OR LOST BUSINESS OR LOST SALES, EVEN IF FIVE POINTS OR SUCH INDIVIDUAL HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.  FIVE POINTS ALSO ASSUMES NO RESPONSIBILITY FOR, AND SHALL NOT BE LIABLE FOR ANY DAMAGES TO, VIRUSES THAT MAY INFECT YOUR COMPUTER EQUIPMENT OR OTHER PROPERTY BECAUSE OF YOUR ACCESS TO, USE OF, OR BROWSING OF THIS SITE. PLEASE NOTE THAT SOME JURISDICTIONS MAY NOT ALLOW THE EXCLUSION OR LIMITATION OF CERTAIN WARRANTIES, SO SOME OF THE ABOVE EXCLUSIONS MAY NOT APPLY TO YOU.

6.    Typographical Errors

Considerable effort is made to ensure the accuracy of all content on the Site. However, neither Five Points nor its employees makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness or usefulness of any information, products, product information or any other materials accessible through this Site.  All terms, prices, configurations and specifications are subject to change without notice or obligation.

In the event that any product offered on this Site by Five Points is mistakenly listed at an incorrect price, Five Points reserves the right to refuse or cancel any orders placed for such products listed at the incorrect price. Five Points reserves the right to refuse or cancel any such orders whether or not the order has been confirmed and your credit card charged. If your credit card has already been charged for the purchase and your order is cancelled, Five Points shall issue a credit to your credit card account in the amount of the incorrect price.

7.    Conditions of Sale; Sales Tax Policy

To purchase any goods and/or services on our Site, you must (a) be at least eighteen (18) years of age or the applicable state age of majority, (b) be a natural person (no corporations, partnerships or other legal entities), and (c) be a resident in the 50 states of the United States of America. Prior to the purchase of any goods or services on our Site, you must provide us with a valid credit card number and associated payment information including all of the following: (i) your name as it appears on the card, (ii) your credit card number, (iii) the credit card type, (iv) the date of expiration and (v) any activation numbers or codes needed to charge your card. By submitting that information to us, you hereby agree that you authorize us to charge your card at our convenience but within thirty (30) days of credit card authorization. You are responsible for paying any governmental taxes imposed on your purchases, including, but not limited to, sales, use or value-added taxes.

8.    Site Communications

Except as expressly provided in this Terms of Use agreement or the Privacy Policy, any communication or material you transmit to the Site by e-mail or otherwise, including any data, questions, comments, suggestions or the like is, and will be treated as, non-confidential and non-proprietary. Anything you transmit may be used by Five Points or its affiliates for any purpose, including, but not limited to, reproduction, disclosure, transmission, publication, broadcast and posting. Furthermore, Five Points shall be free to use any ideas, concepts, know-how or techniques contained in any communication you send to the Site for any purpose whatsoever, including but not limited to developing and marketing products or services using such information.

9.    Off-Site Content

This Site contains links to other web sites, resources or third-parties (collectively referred to as “Linked Sites”).  Five Points does not, however, control these independent web sites and does not provide any assurance, warranty or guarantee of any kind that you will be satisfied with such sites, their products or their services.  You acknowledge and agree that Five Points has no responsibility for the accuracy or availability of information provided by Linked Sites.  Links to Linked Sites are provided as a convenience to you, and Five Points is not responsible for the availability of such external sites and linking to Linked Sites does not constitute an endorsement by or association with Five Points of such sites, or the products, services or other materials presented on such Linked Sites.  Five Points does not author, edit, or monitor these Linked Sites, their terms of use or their privacy practices.  Therefore, Five Points shall not be responsible or liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with use of any Linked Sites.

10.  User Submissions and Conduct

You agree that you will not upload or transmit any communications or content of any type to the Site (including Vlogs, video messages, message boards, etc.) that infringe or violate any rights of any party. It is strictly prohibited to upload or transmit media of any kind that contain expressions of hate, abuse, offensive images or conduct, obscenity, pornography, sexually explicit or any material that could give rise to any civil or criminal liability under applicable law or regulations or that otherwise may be in conflict with these Terms of Use or the Privacy Policy.

You agree that you will not upload any material that contains software viruses or any other computer code, files or programs designed to interrupt, destroy or limit the functionality of any computer, software, or this Site.

11.  Indemnification

You agree to indemnify, defend and hold Five Points, its officers, directors, employees, agents and affiliates harmless from any and all claims, liabilities, damages and/or costs, including reasonable attorneys’ fees, made by any third party due to or arising out of your use of this Site, including any use by your employees, your connection to this Site, your violation of these Terms of Use, your infringement (or infringement by any other user of your login) of any intellectual property or proprietary right of any person or entity, or your violation (or any violation by any other user of your login) of the rights of another. You shall cooperate as fully as reasonably required in the defense of any such claim. Five Points reserves the right, at its own expense, to assume the exclusive defense and control of any matter subject to indemnification by you.

12.  Jurisdiction and Venue

Five Points controls and operates this Site from the United States of America.  Five Points does not represent that materials on this Site are appropriate or available for use in other locations.  Persons or entities who choose to access this Site from other locations do so on their own initiative, and are responsible for compliance with local laws if and to the extent local laws are applicable. Information on this Site may include description of products and services that may be available in the United States of America only. You agree that any legal action brought against Five Points shall be governed by the laws of the State of Tennessee without regard to its conflict of law principles. You agree that the sole jurisdiction and venue for any litigation arising from your use of this Site or orders made through this Site shall be an appropriate federal or state court located in Williamson County, Franklin, Tennessee.

13.  Modifications to this Site

Five Points has the right to modify this Site and any services offered through this Site as described in these Terms of Use and to change, suspend, or discontinue any aspect of this Site at any time, including the availability of any Site feature, database or content. Five Points may also impose limits on certain features and services or restrict your access to parts or this entire Site without notice or liability.

14.  No Waiver

The failure of Five Points to exercise or enforce any right or provision of these Terms of Use shall not constitute a waiver of such right or provision.  If any provision contained in these Terms of Use is found by a court of competent jurisdiction to be unlawful, invalid, or for any reason unenforceable, the parties nevertheless agree that portion shall be construed consistent with applicable law as nearly as possible to reflect the original intention of Five Points and that provision of these Terms of Use shall be deemed severable and shall not affect the validity and enforceability of any remaining provisions.

15.  Entire Agreement

This Agreement constitutes the entire understanding between Five Points and you with respect to this Site and the subject matter hereof, and supersedes all previous agreements between the parties with respect to such subject matter, whether written or oral.  The parties hereto specifically disclaim the U.N. Convention on Contracts for the International Sale of Goods. Neither the course of conduct between the parties hereto nor trade practice shall act to modify these Terms of Use.  Five Points may assign its rights and duties under these Terms of Use to any party at any time without notice.  The section headings used herein are for convenience only and shall not affect the interpretation of these Terms of Use.

16.  Terms of Use Revisions

Five Points reserves the right to modify these Terms of Use.  Five Points will post any changes to these Terms of Use on the site. Continued use of this Site after such postings shall be deemed an acceptance to be bound by the notices, terms and conditions of the modified Terms of Use.

If you have any questions about these Terms of Use, the practices of Five Points, or your dealings with this Site, please contact us at: websecurity@FivePointsICT.com.

17. Privacy. You hereby acknowledge having read and accept and agree to all terms and conditions of Five Points ICT, Inc.’s Privacy Policy, which are hereby incorporated in this Agreement.

18.   HIPAA and Privacy Notice

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

This Notice describes the legal obligations of Five Points ICT, Inc. (Five Points) and your legal rights regarding your protected health information held by Five Points under the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA). Among other things, this Notice describes how your protected health information may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law.

On February 17, 2009 President Obama signed the stimulus bill, the American Recovery and Reinvestment Act (ARRA) into law.  Among numerous provisions designed to provide an economic stimulus to the U.S. economy, ARRA also included the Health Information Technology for Economic and Clinical Health Act (HITECH), which contains new privacy and security requirements applicable to HIPAA covered entities such as Five Points, and their “Business Associates.”

We are required to provide this Notice of Privacy Practices (the “Notice”) to you pursuant to HIPAA. The HIPAA Privacy Rule protects only certain medical information known as “Protected Health Information” or “PHI”. Generally, protected health information is individually identifiable health information, including demographic information, collected from you or created or received by a health care provider, a health care clearinghouse, a health plan, or your employer on behalf of a group health plan that relates to:

(1) Your past, present or future physical or mental health or condition;

(2) The provision of health care to you; or

(3) The past, present or future payment for the provision of health care to you.

You do not have to provide any genetic information when responding to any request we may make for medical information. For this purpose, “genetic information” includes your family medical history, the results of your or your family member’s genetic tests, the fact that you or your family member sought or received genetic services, and genetic information of a fetus carried by you or your family member, or of an embryo held by you or your family member receiving assistive reproductive services.

If you have any questions about this Notice or about our privacy practices, please contact the Five Points ICT Privacy Officer at (615) 791-0404.

Effective Date

This Notice is effective December 1, 2009.

Our Responsibilities

We are required by law to:

  • Maintain the privacy of your protected health information;
  • Provide you with certain rights with respect to your protected health information;
  • Provide you with a copy of this Notice of our legal duties and privacy practices with respect to   your protected health information; and
  • Follow the terms of the Notice that are currently in effect.

We reserve the right to change the terms of this Notice and to make new provisions regarding your protected health information that we maintain, as allowed or required by law.  If we make any material change to this Notice, we will provide you with a copy of our revised Notice of Privacy Practices by posting to our website.

How We May Use and Disclose Your Protected Health Information

Under the law, we may use or disclose your protected health information under certain circumstances without your permission. The following categories describe the different ways that we may use and disclose your protected health information. For each category of uses or disclosures we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment.

We may use or disclose your protected health information to facilitate medical treatment or services by providers. We may disclose medical information about you to providers, including doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you.

For Payment.

We may use or disclose your protected health information to determine your eligibility for Five Points services, to facilitate payment for the treatment and services you receive from health care providers, to determine benefit responsibility, or to coordinate coverage. We may also share your protected health information with a utilization review or pre-certification service provider. Likewise, we may share your protected health information with another entity to assist with the adjudication or subrogation of health claims or to another health plan to coordinate benefit payments.

For Health Care Operations.

We may use and disclose your protected health information for other Five Points operations. These uses and disclosures are necessary to run Five Points’ services. For example, we may use medical information in connection with conducting quality assessment and improvement activities; underwriting, and other activities relating to Five Points including conducting or arranging for medical review, legal services, audit services, and fraud & abuse detection programs; business planning and development such as cost management; and business management and general Five Points administrative activities.

To Business Associates.

We may contract with individuals or entities known as Business Associates to perform various functions on our behalf or to provide certain types of services. In order to perform these functions or to provide these services, Business Associates will receive, create, maintain, use and/or disclose your protected health information, but only after they agree in writing with us to implement appropriate safeguards regarding your protected health information. For example, we may disclose your protected health information to a Business Associate to administer claims or to provide support services, such as utilization management, pharmacy benefit management or subrogation, but only after the Business Associate enters into a Business Associate Agreement with us.

As Required by Law.

We will disclose your protected health information when required to do so by federal, state or local law. For example, we may disclose your protected health information when required by national security laws or public health disclosure laws.

To Avert a Serious Threat to Health or Safety.

We may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. For example, we may disclose your protected health information in a proceeding regarding the licensure of a physician.

To Plan Sponsors.

For the purpose of administering services, we may disclose to certain employees required protected health information. However, those employees will use or disclose that information only as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized further disclosures. Your protected health information cannot be used for employment purposes without your specific authorization.

Special Situations

In addition to the above, the following categories describe other possible ways that we may use and disclose your protected health information. For each category of uses or disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

Workers’ Compensation.

We may release your protected health information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks.

We may disclose your protected health information for public health actions. These actions generally include the following:

  • To prevent or control disease, injury or disability;
  • To report births and deaths;
  • To report child abuse or neglect;
  • To report reactions to medications or problems with products;
  • To notify people of recalls of products they may be using;
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
  • To notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.

Health Oversight Activities.

We may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes.

If you are involved in a lawsuit or a dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement.

We may disclose your protected health information if asked to do so by a law enforcement official:

  • In response to a court order, subpoena, warrant, summons or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim’s agreement;
  • About a death that we believe may be the result of criminal conduct;
  • About criminal conduct; and
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

National Security and Intelligence Activities.

We may release your protected health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Inmates.

If you are an inmate of a correctional institution or are under the custody of a law enforcement official, we may disclose your protected health information to the correctional institution or law enforcement official if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Research.

We may disclose your protected health information to researchers when:

(1)   The individual identifiers have been removed; or

(2)   When an institutional review board or privacy board (a) has reviewed the research proposal; and (b) has established protocols to ensure the privacy of the requested information, and approves the research.

Required Disclosures

The following is a description of disclosures of your protected health information we are required to make.

Government Audits.

We are required to disclose your protected health information to the Secretary of the United States Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA privacy rule.

Disclosures to You.

When you request, we are required to disclose to you the portion of your protected health information that contains medical records, billing records, and any other records used to make decisions regarding your health care benefits. We are also required, when requested, to provide you with an accounting of most disclosures of your protected health information where the disclosure was for reasons other than for payment, treatment or health care operations, and where the protected health information was not disclosed pursuant to your individual authorization.

Other Disclosures

Personal Representatives.

We will disclose your protected health information to individuals authorized by you, or to an individual designated as your personal representative, attorney-in-fact, etc., so long as you provide us with a written notice/authorization and any supporting documents (i.e., power of attorney). Note: Under the HIPAA privacy rule, we do not have to disclose information to a personal representative if we have a reasonable belief that:

(1)   You have been, or may be, subjected to domestic violence, abuse or neglect by such person;

(2)   Treating such person as your personal representative could endanger you; or

(3)   In the exercise of professional judgment, it is not in your best interest to treat the person as your personal representative.

Authorizations.

Other uses or disclosures of your protected health information not described above will only be made with your written authorization. You may revoke written authorization at any time, so long as the revocation is in writing.

Your Rights

You have the following rights with respect to your protected health information:

Right to Inspect and Copy.

You have the right to inspect and copy certain protected health information that may be used to make decisions about your health care benefits. To inspect and copy your protected health information, you must submit your request in writing to Five Points ICT Privacy Officer or Five Points ICT Corporate Compliance, who will assist you in obtaining this information from the appropriate parties.  If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed by submitting a written request to the Five Points ICT Privacy Officer or Five Points ICT Corporate Compliance.

Right to Amend.

If you feel that the protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Plan.

To request an amendment, your request must be made in writing and submitted to Five Points ICT Privacy Officer or Five Points ICT Corporate Compliance.  In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

  • Is not part of the medical information kept by or for Five Points;
  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the information that you would be permitted to inspect and copy; or
  • Is already accurate and complete.

If we deny your request, you have the right to file a statement of disagreement with us and any future disclosures of the disputed information will include your statement.

Right to an Accounting of Disclosures.

You have the right to request an “accounting” of certain disclosures of your protected health information. The accounting will not include (1) disclosures for purposes of treatment, payment, or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to your authorization; (4) disclosures made to friends or family in your presence or because of an emergency; (5) disclosures for national security purposes; and (6) disclosures incidental to otherwise permissible disclosures.

To request this list or accounting of disclosures, you must submit your request in writing to Five Points ICT Privacy Officer or Five Points ICT Corporate Compliance.  Your request must state a time period of no longer than six years and may not include dates before April 14, 2004.

Your request should indicate in what form you want the list (for example, paper or electronic). We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions.

You have the right to request a restriction or limitation on your protected health information that we use or disclose for treatment, payment or health care operations. You also have the right to request a limit on your protected health information that we disclose to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had.

We are not required to agree to your request. However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you.

To request restrictions, you must make your request in writing to Five Points ICT Privacy Officer or Five Points ICT Corporate Compliance. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply—for example, disclosures to your spouse.

Right to Request Confidential Communications.

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to Five Points ICT Privacy Officer or Five Points ICT Corporate Compliance.   We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests if you clearly provide information that the disclosure of all or part of your protected information could endanger you.

Right to a Paper Copy of This Notice.

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.   You may obtain a copy of this notice at our website, www.MyBenefitsChannel.com.

Complaints

If you believe that your privacy rights have been violated, you may file a complaint with the Plan or with the Office for Civil Rights. To file a complaint, please contact: Five Points ICT Privacy Officer, or Five Points ICT Corporate Compliance.  All complaints must be submitted in writing.   You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office of Civil Rights or with us.