NOTICE OF PRIVACY PRACTICES Molina Healthcare of New York, Inc.

Senior Whole Health of New York, Inc. dba “Senior Whole Health by Molina Healthcare” (“Senior Whole Health”, “we” or “our”) uses and shares protected health information about you to provide your health benefits as a Senior Whole Health member. We use and share your information to carry out treatment, payment and health care operations. We also use and share your information for other reasons as allowed and required by law. We have the duty to keep your health information private and to follow the terms of this Notice. The effective date of this Notice is October 1, 2021.

PHI means protected health information. PHI is health information that includes your name, Member number or other identifiers, and is used or shared by Senior Whole Health.

Why does Senior Whole Health use or share your PHI?

We use or share your PHI to provide you with health care benefits. Your PHI is used or shared for treatment, payment, and health care operations.

For Treatment

Senior Whole Health may use or share your PHI to give you, or arrange for, your medical care. This treatment also includes referrals between your doctors or other health care providers. For example, we may share information about your health condition with a specialist. This helps the specialist talk about your treatment with your doctor.

For Payment

Senior Whole Health may use or share PHI to make decisions on payment. This may include claims, approvals for treatment, and decisions about medical need. Your name, your condition, your treatment, and supplies given may be written on the bill. For example, we may let a doctor know that you have our benefits. We would also tell the doctor the amount of the bill that we would pay.

For Health Care Operations

Senior Whole Health may use or share PHI about you to run our health plan. For example, we may use information from your claim to let you know about a health program that could help you. We may also use or share your PHI to solve Member concerns. Your PHI may also be used to see that claims are paid right.

Health care operations involve many daily business needs. It includes but is not limited to, the following:

• Improving quality;
• Actions in health programs to help Members with certain conditions (such as asthma);
• Conducting or arranging for medical review;
• Legal services, including fraud and abuse detection and prosecution programs;
• Actions to help us obey laws;
• Address Member needs, including solving complaints and grievances.

We will share your PHI with other companies (“business associates”) that perform different kinds of activities for our health plan. We may also use your PHI to give you reminders about your appointments. We may use your PHI to give you information about other treatment, or other health-related benefits and services.

When can Senior Whole Health use or share your PHI without getting written authorization (approval) from you?

In addition to treatment, payment and health care operations, the law allows or requires Senior Whole Health to use and share your PHI for several other purposes including the following:

Required by law

We will use or share information about you as required by law. We will share your PHI when required by the Secretary of the Department of Health and Human Services (HHS). This may be for a court case, other legal review, or when required for law enforcement purposes.

Public Health

Your PHI may be used or shared for public health activities. This may include helping public health agencies to prevent or control disease.

Health Care Oversight

Your PHI may be used or shared with government agencies. They may need your PHI for audits.

Research

Your PHI may be used or shared for research in certain cases, such as when approved by a privacy or institutional review board.

Legal or Administrative Proceedings

Your PHI may be used or shared for legal proceedings, such as in response to a court order.

Law Enforcement

Your PHI may be used or shared with police for law enforcement purposes, such as to help find a suspect, witness or missing person.

Health and Safety

Your PHI may be shared to prevent a serious threat to public health or safety.

Government Functions

Your PHI may be shared with the government for special functions. An example would be to protect the President.

Victims of Abuse, Neglect or Domestic Violence

Your PHI may be shared with legal authorities if we believe that a person is a victim of abuse or neglect.

Workers Compensation

Your PHI may be used or shared to obey Workers Compensation laws.

Other Disclosures

Your PHI may be shared with funeral directors or coroners to help them do their jobs.

When does Senior Whole Health need your written authorization (approval) to use or share your PHI?

Senior Whole Health needs your written approval to use or share your PHI for a purpose other than those listed in this Notice. Senior Whole Health needs your authorization before we disclose your PHI for the following: (1) most uses and disclosures of psychotherapy notes; (2) uses and disclosures for marketing purposes; and (3) uses and disclosures that involve the sale of PHI. You may cancel a written approval that you have given us. Your cancellation will not apply to actions already taken by us because of the approval you already gave to us.

What are your health information rights?

You have the right to:

• Request Restrictions on PHI Uses or Disclosures (Sharing of Your PHI)
  You may ask us not to share your PHI to carry out treatment, payment or health care operations. You may also ask us not to share your PHI with family, friends or other persons you name who are involved in your health care. However, we are not required to agree to your request. You will need to make your request in writing. You may use Senior Whole Health’s form to make your request.
• Request Confidential Communications of PHI
  You may ask Senior Whole Health to give you your PHI in a certain way or at a certain place to help keep your PHI private. We will follow reasonable requests, if you tell us how sharing all or a part of that PHI could put your life at risk. You will need to make your request in writing. You may use Senior Whole Health’s form to make your request.
• Review and Copy Your PHI
  You have a right to review and get a copy of your PHI held by us. This may include records used in making coverage, claims and other decisions as a Senior Whole Health Member. You will need to make your request in writing. You may use Senior Whole Health’s form to make your request. We may charge you a reasonable fee for copying and mailing the records. In certain cases, we may deny the request. Important Note: We do not have complete copies of your medical records. If you want to look at, get a copy of, or change your medical records, please contact your doctor or clinic.
• Amend Your PHI
  You may ask that we amend (change) your PHI. This involves only those records kept by us about you as a Member. You will need to make your request in writing. You may use Senior Whole Health’s form to make your request. You may file a letter disagreeing with us if we deny the request.
• Receive an Accounting of PHI Disclosures (Sharing of Your PHI)
  You may ask that we give you a list of certain parties that we shared your PHI with during the six years prior to the date of your request. The list will not include PHI shared as follows:
  • for treatment, payment or health care operations;
  • to persons about their own PHI;
  • sharing done with your authorization;
  • incident to a use or disclosure otherwise permitted or required under applicable law;
  • PHI released in the interest of national security or for intelligence purposes; or
  • as part of a limited data set in accordance with applicable law.

We will charge a reasonable fee for each list if you ask for this list more than once in a 12- month period. You will need to make your request in writing. You may use Senior Whole Health’s form to make your request.

You may make any of the requests listed above, or may get a paper copy of this Notice. Please call Senior Whole Health Member Services at the toll-free phone number on your Senior Whole Health ID card, 7 days a week, 8 a.m. to 8 p.m., local time. TTY/ TDD users, please call 711.

What can you do if your rights have not been protected?

You may complain to Senior Whole Health and to the Department of Health and Human Services if you believe your privacy rights have been violated. We will not do anything against you for filing a complaint. Your care and benefits will not change in any way.

You may file a complaint with us at:

By Phone: Call Senior Whole Health Member Services at the toll-free phone number on your Senior Whole Health ID card, 7 days a week, 8 a.m. to 8 p.m. local time. TTY/TDD users, please call 711.

In Writing: Senior Whole Health Attention: Medicare Appeals and Grievances P.O. Box 22816 Long Beach, CA 90801

You may file a complaint with the Secretary of the U.S. Department of Health and Human Services at:

U.S. Department of Health & Human Services
Office for Civil Rights
200 Independence Ave., S.W.
Suite 509F, HHH Building
Washington, D.C. 20201
(800) 368-1019; (800) 537-7697 (TDD); (202) 619-3818 (FAX)

What are the duties of Senior Whole Health?

Senior Whole Health is required to:

• Keep your PHI private;
• Give you written information such as this on our duties and privacy practices about your PHI;
• Provide you with a notice in the event of any breach of your unsecured PHI;
• Not use or disclose your genetic information for underwriting purposes;
• Follow the terms of this Notice.

This Notice is Subject to Change

Senior Whole Health reserves the right to change its information practices and terms of this Notice at any time. If we do, the new terms and practices will then apply to all PHI we keep. If we make any material changes, Senior Whole Health will post the revised Notice on our web site and send the revised Notice, or information about the material change and how to obtain the revised Notice, in our next annual mailing to our members then covered by Senior Whole Health.

Contact Information

If you have any questions, please contact the following office:

By Phone: Call Senior Whole Health Member Services at the toll-free phone number on your Senior Whole Health ID card, 7 days a week, 8 a.m. to 8 p.m. local time. TTY/TDD users, please call 711.

You can get this document for free in other formats, such as large print, braille, or audio. Call Senior Whole Health Member Services at the toll-free phone number on your Senior Whole Health ID card, 7 days a week, 8 a.m. to 8 p.m. local time. TTY/TDD users, please call 711. The call is free.