Your Information. Your Rights. Our Responsibilities.
In general, your insurance company, not Explore Health, the Oregon Health Insurance Marketplace, nor the Oregon Health Authority (OHA), holds most of your health and claims information. However, because Explore Health is Oregon's State-based Marketplace, we may have some information when we check your eligibility for Marketplace coverage, determine potential eligibility for Oregon Health Plan (OHP) programs, or coordinate with OHP when required.
This notice describes how your medical information may be used and disclosed across Explore Health and OHA programs involved in eligibility and coordination and explains how you can access this information. Please review it carefully.
Your Rights
You have the right to:
- Get a copy of the health and claims records to the extent we have them
- Correct the health and claims records that are in our possession
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we've shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
See page 2 for more information on these rights and how to exercise them
Your Choices
You have some choices in the way that we use and share information about:
- Answering coverage questions from your family and friends
- Marketing our services. We do not use your protected health information (PHI) for marketing without your written permission
- Selling your information. We do not sell your PHI.
See page 3 for more information on these choices and how to exercise them
Our Uses and Disclosures
We may use and share your information as we:
- Conduct our business, including checking eligibility for OHP, Explore Health eligibility, and coordinating with OHP programs
- Do research, including participation in approved Institutional Review Board (IRB) processes that ensure protections for your privacy and rights
- Comply with the law
- Address workers' compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
See pages 3 and 4 for more information on these choices and how to exercise them.
Your Rights
When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities to help you.
Get a copy of your health and claims records
- You can ask to see or get a copy of your health and claims records and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct health and claims records
- You can ask us to correct the health and claims records that we have if you think they are incorrect or incomplete. Ask us how to do this.
- We may say “no" to your request, but we'll tell you why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will consider all reasonable requests, and must say “yes" if you tell us you would be in danger if we do not.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for our operations.
- We are not required to agree to your request, and we may say “no"
Get a list of those with whom we've shared information
- You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, with whom we shared it, and why we shared it.
- We will include all the disclosures except for those about treatment, payment, health care operations, and certain other. We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting us using the information on page 1.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints.
- We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in payment for your care.
- Share information in a disaster relief situation if you are not able to tell us your preference. For example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most psychotherapy notes
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information to:
Run our organization
- We can use and disclose your information to run our organization and contact you when necessary.
- We are not allowed to use genetic information to decide whether we will enroll you in a health plan.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
- We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone's health or safety
Do research
- We can use or share your information for health research, including participation in approved IRB processes that ensure protections for your privacy and rights.
Comply with the law
- We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.
Address workers' compensation, law enforcement, and other government requests
- We can use or share health information about you:
- For workers' compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
- We can share health information about you in response to a court or administrative order, or in response to a court order.
- Federal and State Privacy Laws: Explore Health follows the requirements of federal and state privacy laws, including laws about drug and alcohol abuse and treatment and mental health conditions and treatment.
- If Explore Health releases information to someone else with your approval, the information may not be protected by the privacy rules, and the person receiving the information may not have to protect the information. They may release your information to someone else without your approval.
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We use electronic security safeguards, such as encryption, access controls, and auditing, to protect your information and ensure only authorized staff can access it.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. The Health Insurance Portability and Accountability Act of 1996 requires that we notify you without unreasonable delay and no later than 60 days from discovering the breach.
- We must follow the duties and privacy practices described in this notice.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our website, and we will mail a copy to you if you request us to.
This Notice of Privacy Practices applies to Explore Health (Oregon's health insurance exchange).
To use any of the privacy rights listed above you can contact Explore Health at 855-268-3767 (all relay calls welcome) or explorehealth@oha.oregon.gov.
To request this notice in another language, large print, Braille or other format call 855-268-3767 (all relay calls welcome).
Oregon Health Insurance Marketplace
Oregon Health Authority
PO Box 191
Salem, OR 97308
Email: explorehealth@oha.oregon.gov
Phone: 855-268-3767 (relay calls welcome)