Compliance
2017HITRUST Certified
2018HEDIS NCQA Certified
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION PLEASE REVIEW IT CAREFULLY.
This Notice is being provided to you on behalf of LIBERTY Dental Plan (the “Plan”) (collectively referred to herein as “We” or “Our”). We understand that your medical information is private and confidential. Further, we are required by law to maintain the privacy of “protected health information” or “PHI.” This includes any individually identifiable information that we obtain from you or others that relates to your past, present or future physical or mental health, the health care you have received, or payment for your health care. We will share PHI as needed, to carry out payment or health care operations relating to the services to be provided at the Plan facilities. We follow applicable state laws, in instances where they are more stringent than the federal HIPAA privacy law.
As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of PHI. This notice also discusses the uses and disclosures we will make of your PHI. We must comply with the provisions of this notice as currently in effect. We reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all PHI we maintain. If we make material changes to our privacy policy, we will promptly revise our posted notice. We will communicate changes to our notice through our website, via email, or through member mailings. You can always request a written copy of our most current privacy notice from the Privacy Officer at the Plan. You can also access it on our website at: https://www.libertydentalplan.com/About-LIBERTY/Compliance/HIPAA-Privacy-Notice.aspx.
We can use or disclose your PHI for purposes of treatment, payment and health care operations. For each of these categories of uses and disclosures, we have provided a description and an example below. However, not every use or disclosure will be listed.
We may also use your PHI in the following ways:
Note: Incidental uses and disclosures of PHI sometimes occur and are not considered to be a violation of your rights. Incidental uses and disclosures are by-products of otherwise allowed uses or disclosures which are limited in nature and cannot be reasonably prevented.
Subject to the requirements of applicable law, we will make the following uses and disclosures of your PHI:
Note: Information related to treatment of HIV, substance abuse, or mental health diseases or genetic information may enjoy certain special protections under applicable state and federal law.
Certain uses and disclosures of PHI will be made only with your written authorization, including uses and/or disclosures: (a) of psychotherapy notes (where appropriate); (b) for marketing purposes; and (c) that constitute a sale of PHI under the Privacy Rule. Other uses and disclosures of PHI not covered by this notice or the laws that apply to us will be made only with your written authorization. You have the right to revoke that authorization at any time. By providing that the revocation is in writing, except to the extent that we already have acted in support on your authorization.
If you believe that your privacy rights have been violated, you should immediately contact the Privacy Officer at:
Phone: 888-704-9833 Email: privacy@libertydentalplan.com Fax: 888-273-2718 Online: https://www.libertydentalplan.com/About-LIBERTY/Compliance/Report-Compliance-Concerns.aspx
We will not take action against you for filing a complaint. You also may file a complaint with the Secretary of the U. S. Department of Health and Human Services.
If you have any questions or would like further information about this notice, please contact the Privacy Officer as noted above. This notice became effective on November 1, 2016 and was last reviewed and approved on April 27, 2023.
LIBERTY Dental Plan Corporation, a Delaware Corporation LIBERTY Dental Plan of California, Inc., a California Corporation LIBERTY Benefits Administrators, Inc., a California Corporation LIBERTY Dental Plan of Nevada, Inc., a Nevada Corporation LIBERTY Dental Plan of the Southeast, Inc., a Nevada Corporation LIBERTY Dental Plan of Texas, Inc., a Nevada Corporation LIBERTY Dental, P.A., a Texas Professional Association LIBERTY Dental Plan of Florida, Inc., a Florida Corporation LIBERTY Dental New York, Inc., a New York Corporation LIBERTY Dental and Vision, Inc., a Nevada Corporation LIBERTY Dental Plan of Missouri, Inc., a Missouri Corporation LIBERTY Dental Plan Reinsurance Company, Ltd. LIBERTY Dental Plan of New Jersey, Inc., a New Jersey Corporation LIBERTY Dental Plan East, LLC, a New Jersey Limited Liability Company LIBERTY Dental New York, LLC, a New Jersey Limited Liability Company (LIBERTY Dental New York IPA, LLC in NJ and NY) LIBERTY Dental Plan of Oklahoma, Inc., an Oklahoma Corporation LIBERTY Dental Plan Organization of New Jersey, Inc., a New Jersey Corporation LIBERTY Dental Plan of Arkansas, Inc., an Arkansas Corporation LIBERTY Dental Plan of Maryland, Inc., a Maryland Corporation LIBERTY Dental Plan of Virginia, Inc., a Virginia Corporation LIBERTY Dental Plan of Alabama, Inc., an Alabama Corporation