If you have any questions or concerns, contact our privacy office at systemprivacyoffice@geisinger.edu or customer service. 

Geisinger Health Plan Privacy Notice

We are required by law to maintain the privacy of protected health information (PHI) and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information.

It’s also important to Geisinger Health Plan (GHP) to uphold the trust of our members and those with whom we interact. We are committed to assuring the confidentiality of your PHI. 

PHI is any individually identifiable health information that is created or received by GHP that relates to your past, present or future physical or mental health or condition; the provision of healthcare to you; or the past, present or future payment for the provision of healthcare to you.

The Notice of Privacy Practices applies to all products offered by Geisinger Health Plan, Geisinger Quality Options, Inc., and Geisinger Indemnity Insurance Company, Inc. (collectively referred to herein as “GHP”) all referred to as GHP below.

Uses and Disclosures of Health Information
Additional Uses and Disclosures of Health Information
Individual Member Rights
GHP's Duties
Complaints
Changes to This Notice
Contacts
Effective Date

 

Uses and Disclosures of Protected Health Information

GHP uses and discloses PHI in connection with your treatment, to make payment for your healthcare and for GHP’s healthcare operations. Except as stated below, GHP will not use or disclose your PHI unless you have signed a form that allows GHP to do so.

Treatment: GHP may disclose your PHI to doctors, dentists, pharmacies, hospitals and other caregivers who request it in connection with your treatment. GHP may also disclose your protected health information to healthcare providers in connection with preventive health, early detection and disease and case management programs.

Payment: GHP will use and disclose your PHI to administer your health benefits policy or contract. This may involve verifying eligibility, claims payment, subrogation, utilization review and management, medical necessity review, care coordination, and responding to complaints, appeals and external requests.

Healthcare Operations: GHP will use and disclose your PHI as necessary, and as permitted by law, for its healthcare operations. These healthcare operations include, but are not limited to, credentialing healthcare providers, peer review, business management, accreditation and licensing, utilization review and management, quality improvement and assurance, enrollment, rating and underwriting, reinsurance, compliance, auditing and other functions related to your health benefits plan.

Business Associates: Certain aspects and components of GHP's services are performed through contracts with outside persons or organizations, such as identification card printing, subrogation, accreditation, etc. At times it may be necessary for GHP to provide PHI to one or more of these outside persons or organizations who assist GHP with healthcare operations. GHP will give out as little information as possible to allow our business associates to complete these tasks and GHP requires these business associates to appropriately safeguard the privacy of your information.

Family and friends involved in your care: With your approval, GHP may disclose your PHI to designated family, friends and others involved in your care. You may designate another person to act on your behalf in signing forms or making decisions when you are unable to do so. GHP recognizes the following documentation for member representation in certain circumstances:

• Applicable Durable Power of Attorney
• Legal guardian
• A GHP "Authorized Representative Form"

If a member wishes to designate an authorized representative, he or she must complete and sign an Authorized Representative form. This form can be obtained by calling the Customer Service Team at the telephone number indicated on the back of the member identification card.

If you are unavailable, incapacitated or facing an emergency medical situation and GHP determines that a limited disclosure may be in your best interest, GHP may share limited PHI with such individuals without your authorization.

Certain state/federal laws may limit our Uses and Disclosures even in the case of Treatment, Payment or Healthcare Operations of those medical records of a sensitive nature, including HIV-related records, records of alcohol or substance abuse treatment, mental health records, and records of sexual abuse/assault counseling. We will use and disclose your health information only in compliance of these more restrictive laws that provide greater protection for records in these categories of care.

Special authorizations may be required by state/federal laws to permit disclosures of certain highly sensitive PHI. In certain situations, consistent with applicable regulations or laws, GHP will ask for your written authorization before using or disclosing identifiable health information about you. If you sign an authorization to disclose specific information, you can later revoke that authorization to stop future uses and disclosures.

Unless authorized by you, GHP will not use or disclose genetic information for underwriting purposes.

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Additional uses and disclosures of health information

GHP may also contact its members to provide appointment reminders, information about treatment alternatives, or other health-related benefits and services available to its members. Also, GHP may use or disclose your PHI in the following situations without an authorization.

GHP may release your PHI:

• For any purpose required by law
• For public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations
• As required by law if we suspect child abuse or neglect; we may also release your PHI as required by law if we believe you to be a victim of abuse, neglect, or domestic violence
• To the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls
• To your plan sponsor (employer), provided, however, your plan sponsor must certify that the information provided will be maintained in a confidential manner and not used for employment related decisions or for other employee benefit determinations or in any other manner not permitted by law
• If required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings
• If required to do so by a court or administrative ordered subpoena or discovery request; in most cases you will have notice of such release
• To law enforcement officials as required by law to report wounds and injuries and crimes
• To coroners and/or funeral directors consistent with law
• If necessary to arrange an organ or tissue donation from you or a transplant for you
• For certain research purposes when such research is approved by an institutional review board with established rules to ensure privacy
• If you are a member of the military as required by armed forces services; we may also release your PHI if necessary for national security or intelligence activities
• To workers' compensation agencies if necessary for your workers' compensation benefit determination

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Individual member rights regarding privacy

The Health Insurance Portability and Accountability Act (HIPAA) provides specific rights to all individuals about their PHI. You may request in writing that GHP not use or disclose your PHI for payment, health management or other healthcare operational purposes except when specifically authorized by you, when required by law, or in emergency circumstances. GHP will consider your request but GHP is not legally required to accept it. GHP will not sell your PHI or share it for marketing purposes unless you give us written permission.

To find out more about any of the following rights or request the necessary form(s), call the Customer Service Team at the telephone number indicated on the back of your member identification card or contact the GHP Designated Privacy Specialist as noted in the Contacts section of this notice.

Communications that you receive from GHP containing your health information will be conveyed in a confidential manner. You have the right to request in writing and GHP will process reasonable requests by you to receive communications regarding your protected health information from us by alternative means or at alternative locations.

Unless GHP is given an alternative address, GHP will mail explanation of benefit forms and other mailings containing protected health information to the address that GHP has on record for the subscriber.

In most cases, you have the right to look at or get a copy of your PHI in a designated record set. Generally, a “designated record set” contains medical and billing records, as well as other records that are used to make decisions about your healthcare benefits. However, you may not inspect or copy psychotherapy notes or certain other information that may be contained in a designated record set. If you request copies, GHP may charge reasonable copying and postage fees.

You may also request a copy of your protected health information in electronic format or direct us to transmit it to another entity or individual you choose. If you believe that information in your GHP records is incorrect or incomplete, you have the right to request in writing that GHP correct or add to the existing information.

GHP is not obligated to make all requested corrections but will give careful consideration to each request. Requests for amendment(s) must be in writing, signed by you or your representative, and must state the reasons for the request. If GHP makes a correction that you request, GHP may also notify others who work with us and have copies of the uncorrected record if GHP believes that the notification is necessary.

You can ask for an accounting of disclosures – a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and healthcare operations, and certain other disclosures (such as any you asked us to make). If you request this accounting more than once in a 12-month period, GHP may charge you a reasonable fee.

We are required to notify you, should certain unpermitted uses and disclosures, a “breach”, occurs that may cause you financial, reputational, or other significant harm. This will be done by mail and other means if necessary.

GHP duties

GHP is required by law to maintain the privacy of your PHI, provide this notice about its information practices and follow the information practices that are described in this notice. GHP may change its policies at any time.

If GHP makes a significant change in its policies, GHP will provide notice of the change to you via a letter, newsletter notice or a revised Subscription Certificate. You may request a copy of GHP’s Privacy & Confidentiality policy on uses and disclosures of health information at any time. For more information on GHP’s privacy practices, contact the person listed below.

GHP has procedures in place to prevent unauthorized access to your PHI, which include employee training in the importance of maintaining member confidentiality and privacy. 

GHP will retain your PHI for the period necessary to fulfill the purposes outlined in this Notice of Privacy Practices, including to meet our legal obligations, resolve disputes, and enforce our agreements, unless a longer retention period is required or permitted by law. 

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Changes to this notice

We may change this Notice at any time. We may make the revised or changed notice effective for PHI we already have as well as any PHI we receive in the future. On the first page of the Notice, in the top right corner, you will find the effective date of that Notice.

If we make a material change to Uses and Disclosures, your rights, our legal duties or other privacy practices stated in this Notice, we will promptly revise and distribute our changed Notice. Except when required by law, a material change to any term of this Notice may not be implemented prior to the effective date of the revised Notice.

CMS Blue Button Program

Notwithstanding the other provisions of this Privacy Policy, if you are participating in the Centers for Medicare and Medicaid Services (“CMS”) Blue Button program through Geisinger the following provisions apply to you:

(a) Geisinger will notify you of any material changes to this Notice

(b) We will notify you if Geisinger is sold or merged into another entity

(c) The notice will be provided electronically through the Blue Button portal on Geisinger’s website.

(d) If you inform Geisinger that you are opting out of the Blue Button program through the Blue Button portal, Geisinger will delete the Blue Button information that we received from CMS about you.

Complaints

If you are concerned that GHP has violated your privacy rights or you disagree with a decision GHP has made about access to your GHP records, please follow the complaint procedures described in your plan documents. You can also call the Customer Service Team or contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. Individuals will not be retaliated against for filing a complaint with either GHP or the U.S. Department of Health and Human Services.

Contacts

If you have any questions or need additional information, please contact your Customer Service Team at the telephone number indicated on the back of your member identification card or Geisinger’s Privacy office as follows:

Geisinger Privacy Office
Geisinger Health Plan
100 North Academy Avenue
Danville, PA 17822-8005
MC 40-38
Tel: 570-271-7360
Email: systemprivacyoffice@geisinger.edu

The address for the Department of Health and Human Services is: 

The U.S. Department of Health and Human Services
200 Independence Avenue, S.W. 
Washington, D.C. 20201
Tel: 877-696-6775
Website: http://www.hhs.gov/hipaa/filing-a-complaint/index.html

Effective date

This notice went into effect April 14, 2003, in accordance with the privacy regulations of the Health Insurance Portability and Accountability Act. 

Organized Health Care Arrangement Designation

As covered entities, the bellow-listed separate GH corporate legal entities are participating in an Organized Health Care Arrangement ("OHCA"). These separate corporate legal entities may share PHI as necessary to carry out treatment, payment and healthcare operations related to the OHCA and for other purposes as permitted or required by law.

• Geisinger Affiliated Covered Entities
• Geisinger Indemnity Insurance Company
• Geisinger Quality Options, Inc.
• Geisinger Health Plan

Affiliated Covered Entity Designation

As of October 1, 2019, the following Geisinger covered entities, under common control, designate themselves as a single covered entity known as the “Geisinger Affiliated Covered Entities” for purposes of the HIPAA privacy rule. The Geisinger Affiliated Covered Entities are:

• Geisinger Clinic (all sites)
• Geisinger Medical Center (including its Geisinger Shamokin Area Community Hospital Campus)
• Geisinger Wyoming Valley Medical Center (including Geisinger South Wilkes-Barre Campus)
• Geisinger Community Health Services
• Geisinger Bloomsburg Hospital
• Geisinger Health Plan (Added January 23, 2020)
• Geisinger Jersey Shore Hospital
• Geisinger Lewistown Hospital|
• GNJ Physicians Group PC
• Geisinger Pharmacy LLC
• Community Medical Center d/b/a Geisinger Community Medical Center
• Family Health Associates of Geisinger-Lewistown Hospital
• West Shore Advanced Life Support Services, Inc.
• Geisinger Medical Center Muncy (December 2021) 

Contact Us

If you have questions about the privacy of your health information, call us at 800-447-4000. 

Current revision January 2024

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