***COLORADO SCHOOL OF MINES NOTICE OF PRIVACY PRACTICES***
Effective Date: March 19, 2008
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 carefully.
Why have you been sent this Notice?
The Colorado School of Mines (CSM) Flexible Benefit Program is required under the Privacy Regulations of the Health Insurance
Portability and Accountability Act, 42 U.S.C. § 1320d – 1320d-8, and its implementing regulations, 45 C.F.R. Parts 160 and 164,
(HIPAA) to provide all employees eligible to participate in the Program with this notice of privacy practices. This notice concerns the
personal, protected health information (PHI) you have provided to the Program and any third party administrators in connection with the
flexible spending account provisions of the Program. CSM takes your privacy seriously. Your information will not be used or disclosed
without your written authorization, except as described in this notice or as otherwise permitted by Federal and State law. You may
revoke your authorization as provided by the HIPAA Privacy Regulations.
How do we use your information?
We restrict access to your PHI to those employees of CSM who need to know the information in order to provide services to you. CSM
uses your PHI without your written authorization for purposes of treatment, payment, or health care operations, which are explained
♦ Treatment is health care. For example, the Program may disclose PHI and confirm your program eligibility so that
treatment is provided to you.
♦ Payment is paying claims for health care and related activities. For example, the Program may disclose your PHI to
adjudicate claims and appeals.
♦ Health Care Operations is the administration and operation of the program. For example, the Program may disclose your
PHI to evaluate the quality of service that you receive.
With whom do we share your information? CSM may share your PHI, without your written