Effective Date: April 14, 2003
Ternian Insurance Group LLC 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 REVIEW IT
If you have any questions about this Notice, please contact our Privacy
Office by calling 602-216-0006 or writing to Attn: Privacy Office, Ternian
Insurance Group LLC, 7310 N. 16th Street, Suite 100, Phoenix AZ 85020.
WHO WILL FOLLOW THIS NOTICE
This Notice of Privacy Practices describes the practices of Ternian Insurance
Group LLC. and the following companies that are affiliated with Ternian
Insurance Group LLC.: Alta Coterie Investments LLC and Ternian Technology Group
LLC (collectively, “Ternian”).
OUR COMMITMENT TO YOUR PRIVACY
We understand that medical information about you and your health is personal
and we are committed to protecting that information. We create a record of your
benefits, eligibility status and claims history. We need this record to provide
you with quality health care services and to comply with certain legal
requirements. Hospitals, physicians and other health care providers providing
health care services to you may have different policies or notices regarding
their uses and disclosures of your medical information.
This Notice will tell you about the ways in which we may use and disclose
medical information about you. This Notice will also describe your rights and
certain obligations we have regarding the use and disclosure of medical
We are required by law to: make sure that medical information that identifies
you is kept private; give you this Notice of our legal duties and privacy
practices with respect to medical information about you; and follow the terms of
the Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
Ternian will not disclose your medical information to anyone, except with
your authorization or as otherwise permitted or required by law. For some
activities, we must have your written authorization to use or disclose your
medical information. However, the law permits us to use or disclose your medical
information for the following purposes without your authorization:
We may use and disclose your medical information in order to pay for your
medical benefits. These activities may include making a determination of
eligibility or coverage for insurance benefits, reviewing services provided to
you to determine medical necessity, and undertaking utilization review or case
management activities with respect to your claims. For example, we may use and
disclose your medical information to pay your claims or process your premium
HEALTH CARE OPERATIONS
We may use or disclose medical information about you for our insurance
operations. These uses and disclosures are necessary to run the insurance
company and make sure that our insureds receive quality service. Here are some
examples of the ways that we use your medical information for our health care
operations: creation, renewal, replacement or maintenance of your insurance
contract; placing an insurance contract for reinsurance of our insurance risks;
claims adjudication; disclosures to medical consultants to determine the medical
necessity of treatment recommended by your physician; policy administration,
underwriting and premium rating; eligibility determinations; detection and
investigation of fraud and other unlawful conduct; recovery of overpayments;
conduct of grievances and appeals programs; and disclosures to PPO networks for
purposes of repricing claims.
We may use or disclose your medical information as necessary to provide you
with information about other health-related products or services that are
included in your insurance benefits, including communications about replacement
of, or enhancements to, an insurance contract. For example, your name and
address may be used to send you a newsletter about our organization and your
insurance benefits. You may contact our Privacy Office to opt-out of receiving
such materials. We will not disclose your medical information to third parties
for marketing purposes without your written authorization.
AS REQUIRED BY LAW
We will disclose medical information about you when required to do so by
federal, state or local law. We must also share your medical information with
the Secretary of the Department of Health and Human Services to investigate or
determine our compliance with federal privacy laws.
TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY
We may use and disclose medical information about you when necessary to
prevent a serious threat to your health and safety or to the health and safety
of the public or another person. Any disclosure, however, would only be to
someone able to help prevent the threat.
We also may use or disclose your protected health information in the
following special situations without your authorization. These situations
We may disclose protected health information to a health oversight agency for
activities authorized by law, such as audits, investigations and inspections.
Health oversight agencies include government agencies that oversee health plan
administration, state insurance regulatory authorities and certain other
government regulatory programs.
PUBLIC HEALTH RISKS
We may disclose medical information about you for public health activities.
These activities may include (1) the prevention or control of disease, injury or
disability and (2) notifying people of recalls of products they may be using.
LAWSUITS AND DISPUTES
If you are involved in a lawsuit or a dispute, we may disclose medical
information about you in response to a court or administrative order. We may
also disclose medical information about you 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 (which may include
written notice to you) or to obtain an order protecting the information
We may release medical information if asked to do so by a law enforcement
official: (1) in response to a court order, subpoena, warrant, summons or
similar process; (2) to identify or locate a suspect, fugitive, material witness
or missing person; (3) about the victim of a crime if, under certain limited
circumstances, we are unable to obtain the person’s agreement; (4) about a death
we believe may be the result of criminal conduct; or (5) 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.
FOR SPECIFIC GOVERNMENT FUNCTIONS
We may disclose your medical information for the following specific
government functions: (1) health information of military personnel, as required
by military authorities; (2) health information of inmates, to a correctional
institution or law enforcement official; and (3) for national security reasons.
We may disclose your protected health information as authorized to comply
with workers’ compensation laws and other similar legally established programs.
The following is a statement of your rights with respect to your medical
information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your medical information.
You may inspect and obtain a copy of medical information about you for as
long as we maintain the medical information. We may charge you a fee for the
costs of copying, mailing or other supplies that are necessary to grant your
request. You have the right to choose to obtain a summary instead of a copy of
your medical information.
Under federal law, however, you may not inspect or copy psychotherapy notes
or information compiled in reasonable anticipation of, or for use in a civil,
criminal or administrative action or proceeding. In some circumstances, you may
have the right to have our decision to deny you access to your medical
information reviewed. Please contact our Privacy Office if you have any
questions about access to your medical information.
You have the right to request a restriction on the use and disclosure of your
You have the right to request restrictions on certain uses and disclosures of
your medical information. We are not required to agree to a restriction that you
request. If we do agree to a requested restriction, we will put the agreement in
writing and follow it, except in emergency situations. We cannot agree to limit
uses or disclosures of information that are required by law. You may request a
restriction by writing to or telephoning our Privacy Office.