Effective Date: ____________
LAI-2069629v5
County of Los Angeles Health Care Spending Account Plans
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 CAREFULLY.
WHICH PLANS ARE COVERED BY THIS NOTICE?
This Notice applies to the Los Angeles County Health Care Reimbursement Plans made available under the Flex Plan and MegaFlex
Plan, the Choices Health Care Spending Account Plan, and the Local 721 Health Care Spending Account Plan (together, the "Plans,"
and each, a "Plan"). This Notice summarizes the rules concerning use and disclosure of your protected health information (also known
as "PHI"). Details of the rules summarized in this Notice are contained in the Plans' policies and procedures and the applicable "HIPAA
privacy rules" contained in the Code of Federal Regulations at 45 C.F.R. Parts 160 and 164 and issued under the Health Insurance
Portability and Accountability Act of 1996, as amended.
The Plans are required to maintain the privacy of your health information, provide you with this Notice of their legal duties and privacy
practices with regard to your health information, and comply with the terms of the Notice currently in effect. This Notice describes how
your protected personal health information may be used or disclosed by the Plans to carry out payment or healthcare operations and for
other purposes that are permitted or required by law. It also describes your rights to access and control of your protected health
information. This Notice has been drafted and provided to you in accordance with the HIPAA privacy rules.
The County, as plan sponsor, has elected to restrict its access to your protected health information in order to help protect your privacy.
Only those County employees who assist with the Plans' administration (“Administrative Personnel”) will have access to your protected
health information. Moreover, Administrative Personnel will have limited ac