Employee Benefits Department
Farmington, MI 48336-2363
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.
USE AND DISCLOSURE OF HEALTH INFORMATION
Farmington Public Schools’ Health Plan (“Health Plan”) may use health information that is protected by the Privacy
Rule promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), for purposes
of making or obtaining payment for your care and conducting health care operations. Health Plan has established a
policy to guard against unnecessary disclosure of your health information that is maintained on its behalf by its
“Business Associates”, as defined by HIPAA, including its Agent(s) of Record, MEBS, Inc, BeneCard, Health Alliance
Plan, ADN /FPS Dental, MESSA/VSP Vision, and Ceridian/Great Lakes Strategies for the Section 125 Plan. Please
be advised that Blue Cross Blue Shield of Michigan has issued a separate Notice regarding disclosure of health
information that is maintained on the Plan’s behalf by BCBSM.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH
YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
To Make or Obtain Payment. Health Plan may use or disclose your health information to make payment to or collect
payment from third parties, such as other health plans or providers, for the care you receive. For example, Health
Plan may provide information regarding your coverage or health care treatment to other health plans to coordinate
payment of benefits.
To Conduct Health Care Operations. Health Plan may use or disclose health information for its own operations to
facilitate the administration of Health Plan and as necessary to provide coverage and services to all of Health Plan’s
participants. Health care operations includes such activities as:
Quality assessment and improvement ac