LAST UPDATE: 12/12/2019
Any medical or health information we collect about you will be
to third parties only to underwrite insurance or administer your
or claim, as permitted by law or as authorized by you, consistent
1. Statement of Our Duties
We are committed to protecting the privacy of your protected health
information (PHI). PHI is your individually identifiable health
information, including demographic information, collected from you
created or received by a health care provider, a health plan, your
employer, or health care clearinghouse which is then provided to us
that relates to: (i) your past, present or future physical or mental
health or condition; (ii) the provision of health care to you; or
the past, present or future payment for the provision of health care
you. We are required by law to maintain the privacy of your PHI and
provide you with this notice of our privacy practices and legal
We are required to abide by the terms of this notice.
WE RESERVE THE RIGHT TO CHANGE THE TERMS OF THIS NOTICE AND MAKE ANY
PROVISIONS EFFECTIVE TO ALL OF THE PHI WE MAINTAIN ABOUT YOU. IF WE
CHANGE OUR NOTICE, WE WILL POST IT ON OUR WEBSITE AND SEND YOU A
OUR ANNUAL MAILING, OR YOU MAY OBTAIN A COPY OF THE REVISED NOTICE
CONTACTING OUR PRIVACY COORDINATOR USING THE INFORMATION IN
2. Statement of Your Rights
You have a right to know how we may use or disclose your PHI. This
notice informs you of those uses and disclosures. There are certain
and disclosures of your PHI that we are permitted or required to
law without your permission. For all other uses and disclosures, we
first must obtain your permission or written authorization. In
you have the following rights:
- The right to request, in writing, that we place additional
restrictions on our uses and disclosures of your PHI. However,
are not obligated to agree to impose any such additional
- The right to access, inspect and copy the protected information
pertaining to you that we maintain in our files about you, and
right to have us correct or amend any information that we create
error. Requests to access or amend your PHI must be made in
and sent to the contact person and address provided in paragraph
- The right to receive an accounting of the disclosures of your
that we make for purposes other than activities related to your
treatment, or our payment functions or other health care
You must request an accounting in writing by contacting us at
address in paragraph 9. Your request may be for disclosures made
to 6 years before the date of your request, but in no event, for
disclosures made before April 14, 2003.
- The right to request, in writing, that you receive
about your PHI in a confidential manner, for example, by
means or an alternative location, such as your work address or
- The right to request an amendment to your PHI if you believe
your PHI is incorrect or incomplete. Your request must be in
and explain why the PHI should be amended.
- The right to obtain a paper copy of this notice from us on
3. Information We Collect About You
In order to administer your health benefit programs effectively, we
collect the following categories of PHI about you from the following
- PHI that we obtain directly from you, in conversations or on
applications or other forms that you fill out.
- PHI that we obtain as a result of our transactions with you.
- PHI that we obtain from your medical records or from medical
professionals, which is provided by you or to us with your
- PHI that we obtain from other entities, such as health care
providers or other insurance companies, in order to service your
policy or carry out other insurance-related needs.
4. Uses and Disclosures of Protected Information
A. For Treatment, Payment and Operations.
In order to administer your health benefit programs effectively, we
and disclose PHI for certain of our activities, including:
- To Carry Out Treatment Functions. We may use or disclose your
without your permission to enable health care providers to
you with treatment.
- To Carry Out Payment Functions. We may use or disclose your PHI
without your permission to carry out activities relating to
reimbursing you for the provision of health care, obtaining
premiums, determining coverage, and providing benefits under the
policy of insurance that you are purchasing, such as enabling a
health care provider to make payment arrangements. Such
may include reviewing health care services with respect to
necessity, coverage under the policy, appropriateness of care,
justification of charges.
- To Carry Out Certain Operations Relating To Your Benefit Plan.
also may use or disclose your PHI without your permission to
out certain limited activities relating to your health insurance
benefits, including reviewing the competence or qualifications
health care professionals, placing contracts for stop-loss
and conducting quality assessment activities.
- To facilitate the underwriting of insurance; however, we are
prohibited from using or disclosing your genetic information for
purpose of underwriting insurance.
B. Uses and Disclosures of PHI to Other Entities.
We also may use and disclose PHI to other covered entities, business
associates or other individuals (as permitted by the HIPAA Privacy
who assist us in administering your benefit plan and delivering
to its members. In connection with our payment and operations
activities, we may contact individuals and other entities ("Business
Associates") to perform various functions on our behalf or to
certain types of services (such as enrollment or member service
support). To perform these functions, Business Associates must agree
writing to contract terms designed to appropriately safeguard your
C. Other Possible Uses and Disclosures of PHI
We may use and disclose your PHI without your written permission for
- To plan sponsors of your group health plan to permit the plan
sponsor to perform administrative functions, such as to address
member questions, concerns or issue regarding claims, benefits,
services, coverage, etc., and summary health information about
enrollees in the plan to obtain premium bids for health
coverage offered through the group health plan or to modify,
or terminate your group plan.
- To the extent that federal or state law requires the use or
disclosure, such as to Health and Human services upon request
purposes of determining compliance with federal privacy laws, as
required by law enforcement officials or pursuant to a court
- As authorized by and to the extent necessary to comply with
compensation or other similar programs that provide benefits for
work-related injuries or illnesses.
- As authorized by law and to the extent necessary to service
insurance policies and benefits that are exempt benefits, such
connection with servicing life, disability, property and
accident and sickness, workers' compensation and auto insurance
other similar insurance coverage under which benefits for
care are secondary or incidental to other insurance benefits.
- To a public health authority for purposes of public health
activities as permitted or required by law.
- To a coroner/medical examiner for purposes of identifying a
person, determining cause of death or for such official to
other duties authorized by law. Also to funeral directors so
may carry out their duties, and to organizations that handle
eye or tissue donation or transplantation.
- To a government authority, including a social service or
services agency, authorized to receive reports of abuse, neglect
domestic violence or to prevent a serious threat to the health
safety of the public.
D. For Any Purposes to Which You Have Not Objected.
Unless you object, we may disclose your PHI to a friend or family
that you have identified as being involved in your health care. We
may disclose your PHI to an entity to assist in disaster relief
and so that your family can be notified about your condition, status
location. If you are not present or able to agree to these
of your PHI, then we may determine whether the disclosure is in your
E. As Permitted By Plan Documents.
In certain limited circumstances where we may be acting as a third
administrator, we may disclose your PHI to plan sponsors pursuant to
restrictions imposed on the plan sponsor in the sponsor's plan
5. Required Disclosures of Your PHI
We are required to disclose your PHI to the Secretary of the U.S.
Department of Health and Human Services when the Secretary is
investigating or determining compliance with the HIPAA Privacy Rule.
are required to disclose to you most of your PHI that is in a
"designated record set" when you request access to this information.
are also required to provide, upon written request, an accounting of
disclosures of PHI that are for reasons other than payment or health
6. Other Uses and Disclosures of Your PHI
Sometimes we are required to obtain written authorization for use
disclosure of your health information. The uses and disclosures that
require an authorization under 45 C.F.R. §164.508(a) are: (i) for
marketing purposes; (ii) if we intend to sell your PHI; or (iii) for
psychotherapy notes. We do not and will not sell or share your PHI
any non-affiliated third party for any purpose unless you authorize
or it is otherwise permitted by law. Other uses and disclosures of
PHI that are not described above will be made only with your
permission, and any permission that you give us may be revoked by
any time. However, the revocation will not be effective for
that we already have used or disclosed, relying on the
7. Questions and Complaints About Use of PHI
If you want more information about our privacy policies or practices
have any questions or concerns, please contact us using the
in paragraph 9. You may submit a written complaint either directly
or to the U.S. Department of Health and Human Services (HHS) if you
believe that your rights with respect to our protection of your PHI
been violated. We will provide you with the address to file your
complaint with HHS upon request. To file a complaint with us, you
submit a complaint in writing that includes as many details (such as
names and dates) as possible to our Privacy Officer at the address
Paragraph 9. We support your right to protect the privacy of your
You will not be retaliated against in any way for filing a
8. Our Practices Regarding Confidentiality and
We restrict access to PHI about you to those employees who need to
that information in order to provide products or services to you. We
maintain physical, electronic, and procedural safeguards that comply
with federal regulations to guard your PHI. We do not engaged in
fundraising activities using PHI, however, if we did engage in such
activity, then you would have the opportunity to opt out of
fundraising communications. Subject to applicable regulatory
requirements, exceptions and safe harbors, we will notify affected
individuals following a breach of their unsecured PHI.
9. Contact Person For Filing Complaint or Obtaining Further
GLATFELTER INSURANCE GROUP
ATTN: PRIVACY COORDINATOR
P.O. BOX 2726
YORK, PENNSYLVANIA 17405
Our Policy Regarding Dispute
Any controversy or claim arising out of or relating to our
policy, or the breach thereof, shall be settled by arbitration
accordance with the rules of the American Arbitration
and judgment upon the award rendered by the arbitrator(s) may be
entered in any court having jurisdiction thereof.
Glatfelter Insurance Group Family of
This Notice is being provided on behalf of the following Glatfelter
Insurance Group affiliates:
Arthur J. Glatfelter Agency, Inc.
Glatfelter Brokerage Services
Glatfelter Claims Management, Inc.
Glatfelter Commercial Ambulance
Glatfelter Healthcare Practice
Glatfelter Insurance Services
Glatfelter Program Managers
Glatfelter Public Practice
Glatfelter Religious Practice
Glatfelter Underwriting Services, Inc.
Susquehanna Agents Alliance, LLC
The Glatfelter Agency, Inc.
Volunteer Firemen's Insurance Services, Inc.
Changes to this HIPAA
We may change or update this HIPAA Notice from time to time. When we
we will post the revised HIPAA Notice on this page with a new "Last