Effective Date of this Notice: April 14, 2003
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Delta Dental Plan of New Mexico, Inc.
Notice Of Privacy Practices For Protected Health Information
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
Dear Delta Dental Subscriber:
This notice describes how Delta Dental Plan of New Mexico, Inc., ("Delta Dental") protects the medical
information we have about you which relates to your dental benefit coverage. We understand that medical
information about you and your health is private. Delta Dental is committed to protecting the confidentiality and
security of your medical information.
We are required to provide this notice to you by law, specifically, the Health Insurance Portability and
Accountability Act of 1996 ("HIPAA"). We must:
• make certain we maintain the privacy of your Protected Health Information;
give you this notice of our legal duties and privacy practices with respect to your Protected Health
follow the terms of the notice that is currently in effect, and
describe your rights with respect to your Protected Health Information and how you can exercise
This notice was effective April 14, 2003 and will remain in effect until we replace it.
Protected Health Information is information about you that may identify you and that relates to your past, present
or future health, treatment, or payment for health care services. This notice applies to all of the medical records
we maintain. Your personal dentist may have different policies or notices regarding the dentist’s use and
disclosure of your medical information created in the dentist’s office.
We protect your Protected Health Information from inappropriate use or disclosure. Our employees, and those of
companies that help us service your dental benefits, are required to comply with our requirements that protect the