PLEASE REVIEW THIS CAREFULLY

We are providing this Notice from the Philadelphia Federation of Teachers Health and Welfare Fund (referred to in this Notice as the “Fund”) in order to inform you about the way that your health information may be used by the Fund. A federal law, the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), provides your health information with important protection.

The Fund is required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices that are outlined in this notice. As permitted by law, the Fund reserves the right to amend or modify its privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Regardless of the reason for the revision, we will provide you with a revised notice within sixty (60) days of such changes. The effective date of this notice is April 14, 2003.

Under HIPAA, how can the Fund use my health information? The Fund can use your health information to make or obtain payment for your treatment and for health plan operations, including administration, oversight, and other legal purposes.

How may the Fund use my health information with respect to payment for my treatment? The Fund may use your health information for the broad range of actions needed to make sure that the Fund makes payment for the services you and your family receive. The Fund may use your health information making payment to providers for services or treatment you received, for making arrangements for payment through one of the networks of providers through which the Fund provides benefits to you, as well as for coordinating payment to providers through other plans under the Fund’s coordination of benefit rules. For example, the Fund provides participants with access to a network of providers through HealthAmerica. The Fund may provide health information to HealthAmerica and directly to the provider in order to ensure that the provider receives the appropriate payment for the services that have been provided to you.

Does HIPAA permit the Fund to use my health information for other purposes? HIPAA provides that the Fund may use the health information of the individuals the Fund covers for “health care operations.” This includes the broad range of actions required to assess the quality of the Fund’s plan of benefits an its administration and operations. They include, but are not limited to, ensuring that participants or their beneficiaries are eligible for certain benefits prior to payment or taking corrective action to recoup overpayments, assessment of health plan performance; review of the Fund’s plan of benefits and determining whether a reduction in costs is possible; case management and coordination of care; actuarial studies relating to the cost of benefits; management studies relating to the operation and administration of the plan; resolution of internal grievances; and medical review, legal services, and auditing functions. For example, the Fund may use health information to determine the most cost-effective manner to provide vision benefits to its participants and beneficiaries.

May the Fund use my health information for purposes besides payment and health care operations? Yes. HIPAA permits the Fund to use your health information for a number of other purposes, including treatment alternatives or other health-related benefits that may be of interest to you.

Does HIPAA permit the Fund to disclose my health information to my employer? Under HIPAA, the Fund generally cannot disclose your personal health information to your employer without your written authorization. It is important to note, however, that HIPAA does permit that the Fund disclose your health information without your authorization to workers’ compensation insurers, State administrators, or others involved in the workers’ compensation systems to the extent the disclosure is required by state or other law.

May the Fund release my personal health information to the Fund’s plan sponsor? HIPAA does permit the Fund to disclose information to the “plan sponsor” for administrative functions. Here, the “plan sponsor” is the Fund’s Board of Trustees. The Fund may also provide summary health information to the plan sponsor so that the plan sponsor may solicit premium bids or modify, amend, or terminate the plan.

May the Fund release my personal health information to law enforcement or other governmental entities? Your health information may be disclosed to law enforcement agencies, without your authorization or permission, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government-mandated reporting. Note, however, that the Fund may not disclose your health information if you are the subject of an investigation that does not arise out of or is directly related to your receipt of health care or public benefits. In addition, the Fund may disclose your personal health information in the course of a judicial or administrative proceeding if the Fund receives a court order, subpoena, discovery request or other lawful process. Before releasing this information, the Fund will make reasonable efforts either to notify you or to obtain an order protecting your health information.

Would the Fund release my personal health information if my health or safety or public health or safety would be jeopardized if it did not? If the Fund has a good faith belief that your health or safety or public health or safety would be jeopardized if it did not disclose the information, the Fund will do so, after consideration of appropriate legal and ethical standards.

Must the Fund have an authorization to release my health information? Disclosure of your health information or its use for any purpose other than those described above requires your written authorization. This means that if you want your spouse, friend, relative, or union representative to check on the status of a claim you submitted or to advise when or if payment will be made, you must sign an authorization form and submit it to the Fund Office. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you provided written notice to the Fund of your decision to revoke the authorization.

Do I have rights under the federal privacy standards? Your rights to information under HIPAA include:

· the right to request restrictions on the use and disclosure of your protected health information. The Fund will carefully consider, although is not required to honor, your request for restrictions;

· the right to receive confidential communications concerning your medical conditions or treatment if you believe that disclosure of this information could endanger you (this means, for example, that you can make a written request that the Fund send information about your medical treatment to a post office box or an address different from your home address in order to ensure that your health information remain confidential). The Fund will attempt to honor reasonable requests;

· the right to inspect and copy your protected health information. The Fund may charge a reasonable fee for copying, assembling and postage;

· the right to amend or submit corrections to your protected health information. If you believe that the information in your records are inaccurate or incomplete, you may submit a written request to correct these records. The Fund may deny your request if, for example, you do not include the reason you wish to correct your records or if the records were not created by the Fund.;

· the right to receive an accounting of how and to whom your protected health information has been disclosed if it was disclosed for reasons other than payment or health care operations. Your written request for information must be submitted to the Fund and should state the period of time for which you are requesting an accounting;

· the right to file a complaint that your privacy rights have been violated to the Fund and to the Secretary of U.S. Department of Health & Human Services. Note: you will not be penalized or otherwise retaliated against for filing a complaint;

· the right to receive a printed copy of this notice. You can find this notice on the Fund’s website at www.PFTHW.org.

Complaints? Comments? Requests? The Fund has designated Arthur Steinberg as the Privacy Officer. If you wish to request information to which you have a right to or to file a Complaint with the Fund or if you have any questions regarding this notice, you should address them to Mr. Steinberg. You can call him at 215-561-2722 or write to him at Philadelphia Federation of Teachers Health & Welfare Fund, 1816 Chestnut Street, Philadelphia, PA 19103. Please note that the Fund can assess reasonable charges for copying, assembling documents you request, as well as for postage.

April 4, 2003