Administrative/Legal Information
- Plan Documents
Your Certificate of Coverage (COC) or Summary Plan Description (SPD) explains the benefits you and your covered family members have under your plan. These documents explain the services that will and will not be covered, and it outlines your obligations, such as when you are required to make copayments and pay deductibles and details the appeal process you should follow if you disagree with a decision we made on your or a family member’s claim.
You can find your plan documents, along with other benefit information, on NebraskaBlue.com/Plans.
Contact your employer for a copy of your plan document.
- General Complaints
You have the right to make a complaint or file an appeal about your health plan, any care you receive or any benefit determination your health plan makes. To file a complaint, please call the Member Services number on the back of your member ID card.
- Privacy Information
Please take a moment to read this information. While we have always followed strict policies to maintain the confidentiality of your records, some modifications to our policies have been mandated by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), which is discussed in more detail below. HIPAA affects how we communicate with you and other adult members of your family- Written Communications and Correspondence: All members of a family who are 18 years or older are treated as “Adult Members,” which means that any correspondence that contains protected health information (as defined by HIPAA) is addressed and sent to them in their own name. This correspondence includes, among other things, Explanation of Benefits (EOBs).
- Telephone Inquiries: Blue Cross and Blue Shield of Nebraska discusses questions pertaining to an “Adult Member” with that person only. In order to discuss their information with any other person, even a family member, the “Adult Member” must submit a completed and signed Authorization for Release of Protected Health Information form.
What does this mean for you and your family?
- We do not need an authorization form to talk with you about your own protected health information.
- We do not need an authorization form to communicate with your doctor or other health care providers.
- You do not need to sign an authorization form unless you want to allow us to talk to your spouse or any other individual about your protected health information. In those cases, we need an authorization form from you designating that individual or those individuals.
- If you want to call us regarding claim status, eligibility, preauthorization, individual and family deductibles or any other information regarding your spouse or an “Adult Member” of your family, we need to have an authorization form on file from that “Adult Member.” Otherwise, we can only discuss the protected health information directly with the “Adult Member.” (“Adult Members” include children who have reached the age of majority.)
- We also need an authorization form on file for anyone else outside your family to receive your protected health information. This would include another person such as an executor, legal or personal representative.
Import considerations and next steps
Authorizations are not a requirement. It is the choice of each “Adult Member.” However, some families prefer to have a certain family member handle all health care and health insurance matters. That arrangement may continue, but only if authorizations are signed by the other “Adult Members” of the family.
If you have any questions about the information, please visit NebraskaBlue.com/Privacy or call the Member Services number on the back of your ID card.
Non-Discrimination Notice
Blue Cross and Blue Shield of Nebraska (BCBSNE) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. BCBSNE does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.
BCBSNE:
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats, other formats). Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
- Written Communications and Correspondence: All members of a family who are 18 years or older are treated as “Adult Members,” which means that any correspondence that contains protected health information (as defined by HIPAA) is addressed and sent to them in their own name. This correspondence includes, among other things, Explanation of Benefits (EOBs).
- Notice of Privacy Practices
At Blue Cross and Blue Shield of Nebraska, maintaining the privacy of your protected health information (PHI) is very important to us. Please read this information carefully as it provides insight about how we use and disclose your PHI and how you can access it.
PHI means information about you that is unique to you, including your name, address, telephone number, and Social Security Number. It’s also health information that we have gotten from you or from hospitals, doctors, other health care providers, health insurance companies, your employer and/or health care information clearinghouses relating to:- your past, present, or future physical or mental health or condition
- the delivery of health care to you
- past, present, or future payment for health care services you receive.
This Notice of Privacy Practices document describes how Blue Cross and Blue Shield of Nebraska may use and/or disclose your PHI. It also describes the rights you have regarding your PHI. In this notice, “you” refers to you, our customer, and your covered family members. “We” means Blue Cross and Blue Shield of Nebraska.
We are required by federal and state laws to maintain the privacy of your PHI. We are also required to provide you with this notice about our privacy practices, our legal duties, and your rights concerning your PHI. We must follow the privacy practices described in this notice. These privacy practices will remain in effect until we replace or revise them.
We reserve the right to change our privacy practices as described in this document at any time, provided it is permitted by law. We may make changes to our PHI privacy practices, including PHI that we received or created before the change was made. Before we make a significant change in our privacy practices, we will revise this notice and send it to you.
You may have additional privacy rights under state law. State laws that provide greater privacy protection or rights will continue to apply.
You may request a copy of our Notice of Privacy Practices at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us at the address or phone number shown on the last page of this notice.
Permitted and Required Uses and/ or Disclosures of Protected Health Information
Uses and/or Disclosures for Treatment, Payment and Health Care Operations
In order to administer our health care plans effectively, we will collect, use and disclose PHI for certain types of activities, including benefit payment and health care operations. The following is a description of how we may use and/or disclose PHI about you for payment and health care operations:
Treatment. We do not conduct treatment activities. However, we may disclose your PHI to doctors, hospitals, and other health care providers who request it in connection with your treatment.
Payment. We may use and/or disclose your PHI for all activities that are included within the HIPAA* Privacy Rule’s definition of “payment.” For example, we may use and/or disclose your PHI to pay claims from doctors, hospitals, pharmacies and others for services delivered to you that are covered by your health plan, to determine your eligibility for benefits, to coordinate benefits, to examine medical necessity, to obtain premiums, and to issue Explanations of Benefits. We have not listed here all of the activities included within HIPAA’s definition of “payment,” so please refer to the HIPAA Privacy Rule for a complete list. More information about HIPAA and the Privacy Rule may be found at hhs.gov/ocr/privacy/hipaa/understanding/summary/.
Health Care Operations. We may use and/or disclose your PHI for all activities that are included within the HIPAA Privacy Rule’s definition of “health care operations.” For example, we may use and/or disclose your PHI to determine the premium for your health plan, to conduct quality assessment and improvement activities, to credential health care providers, to engage in care coordination or case management, and/or to manage our business. We have not listed here all of the activities included within the definition of “health care operations,” so please refer to the HIPAA Privacy Rule for a complete list. NOTE: We will not use or disclose your genetic information, including family history, for underwriting purposes.
Uses and/or Disclosures of PHI to Other Entities
We may use and/or disclose your PHI to other entities in the following situations (as permitted by the HIPAA Privacy Rule):
Business Associates. In connection with benefit payment and health care operations activities, we contract with individuals and entities (called “business associates”) to perform various functions on our behalf or to provide certain types of services (such as member service support, utilization management, subrogation, or pharmacy benefit management). To perform these functions or to provide the services, business associates will receive, create, maintain, use, or disclose PHI, but only after the business associates agree to appropriately safeguard your information.
Providers and Other Covered Entities. In addition, we may use and/or disclose your PHI to assist health care providers in connection with their treatment or payment activities, or to assist other covered entities in connection with their payment activities and certain other health care operations. For example, we may disclose your PHI to a health care provider when it is needed to treat you, or we may disclose PHI to another covered entity to conduct health care operations in the areas of quality assurance and improvement activities, or accreditation, certification, licensing or credentialing.
Other Permitted Uses and/or Disclosures of Protected Health Information
We may also use and/or disclose your PHI without your authorization in the following situations:
Others Involved in Your Health Care. If you provide us with verbal permission, we may disclose the PHI you specify to a family member,
another relative, a close friend or any other individual you have identified as being involved in your health care. This verbal permission is valid for one encounter and is not a substitute for written authorization. If you are not present or able to agree to these disclosures of your PHI due to a situation such as a medical emergency or disaster relief, then we may, using our professional judgment, determine whether the disclosure is in your best interest.
Required By Law. We may use and/or disclose your PHI when required to do so by state or federal law.
Public Health Activities. We may use and/or disclose your PHI for public health activities that are permitted or required by law. For example, we may use and/or disclose information for the purpose of preventing or controlling disease, injury, or disability. Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law, such as: audits; investigations; inspections; licensure or disciplinary actions; or civil, administrative, or criminal proceedings or actions. Oversight agencies seeking this information include government agencies that oversee: (1) the health care system; (2) government benefit programs; (3) other government regulatory programs; and (4) compliance with civil rights laws.
Health-Related Products and Services. Where permitted by law, we may use your PHI to communicate with you about health-related products, benefits and services, and payment for those products, benefits and services that we provide or include in our benefits plan. We may use your PHI to communicate with you about treatment alternatives that may be of interest to you. These communications may include information about health care providers in our networks, about replacement of or enhancements to your health plan, and about health-related products or services that are available only to our members that add value to our benefit plans.
Abuse or Neglect. We may disclose your PHI to a government authority that is authorized by law to receive reports of abuse, neglect, or domestic violence.
Public Health and Safety. We may, when necessary, disclose your PHI to avert a serious or imminent threat to your health or safety or the health or safety of others.
Law Enforcement. We may disclose limited information to a law enforcement official concerning the PHI of a suspect, fugitive, material witness, crime victim or missing person.
Legal Proceedings. We may disclose your PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process. Under limited circumstances (such as a court order, warrant or grand jury subpoena) we may also disclose your PHI to law enforcement officials.
Coroners, Medical Examiners, Funeral Directors, and Organ Donation. We may disclose PHI to a coroner or medical examiner for purposes of identifying a deceased person, determining a cause of death, or for the coroner or medical examiner to perform other duties authorized by law. We also may disclose, as authorized by law, information to funeral directors so that they may carry out their duties. Further, we may disclose PHI to organizations that handle organ, eye, or tissue donation and transplantation.
Research. We may disclose your PHI to researchers when an Institutional Review Board or privacy board has: (1) reviewed the research proposal and established protocols to ensure the privacy of the information; and (2) approved the research.
Military and National Security. We may disclose the PHI of armed forces personnel to military authorities under certain circumstances. We may disclose to authorized federal officials any PHI required for lawful intelligence, counterintelligence and other national security activities.
Inmates. We may disclose the PHI of inmates of a correctional institution to the correctional institution or to a law enforcement official for: (1) the institution to provide health care; (2) the inmate’s health and safety and the health and safety of others; or (3) the safety and security of the correctional institution. Workers’ Compensation. We may disclose your PHI to comply with workers’ compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.
Workers’ Compensation. We may disclose your PHI to comply with workers’ compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.
Group Health Plan. We may disclose your PHI to your group health plan to allow the performance of plan administration functions.
Plan Sponsors (if applicable). We may disclose your PHI to your group health plan’s sponsor to allow the performance of plan documents for a full explanation of the limited uses and disclosures the sponsor may make of your PHI to administer your plan.
Required Disclosures of Protected Health Information
The following is a description of disclosures that we are required by law to make:
Disclosures to the Secretary of the U.S. Department of Health and Human Services. We are required to disclose your PHI to the Secretary of the U.S. Department of Health and Human Services when the Secretary is investigating or determining our compliance with the HIPAA Privacy Rule.
Disclosures to You. We are required to provide you with your PHI upon request, as described below in the “Individual Rights” section of this notice. We are also required to provide you with the PHI of any individual on whose behalf you are acting as a personal representative.
Uses and/or Disclosures of PHI with an Authorization
Your authorization is required for us to use and/or disclose your PHI in any situation not listed in the previous section. We may not use and/or disclose your PHI without your written authorization for any reason except those described in this notice. You may give us a written authorization to use your PHI or to disclose it to anyone you specify. If you give us this authorization, you may revoke it in writing at any time, except to the extent that action has already been taken in reliance upon the authorization.
- If we maintain or receive psychotherapy notes about you, most disclosures of these notes require your authorization.
- To the extent (if any) that we might use or disclose your PHI for our fundraising practices, we will provide you with the ability to opt out of future fundraising communications.
- Most (but not all) uses and disclosures of your PHI for marketing purposes. Disclosures that constitute a sale of PHI require your authorization.
Individual Rights
You have certain rights related to your PHI.
Right to Request Restrictions. You have the right to request that we place additional restrictions on our use and/or disclosure of your PHI for treatment, payment or health care operations. We are not required to agree to any additional restrictions; however, if we do, we will abide by those restrictions (except in emergency situations). To request additional restrictions, you must complete and sign a form available by contacting us at the address or phone number listed at the end of this notice.
Right to Receive Confidential Communications. You have the right to request that we communicate with you confidentially about your PHI by alternative means and/ or to an alternative location. Your request must provide the alternative means and/or location for communicating your PHI with you and clearly state that failure to do so could endanger your physical safety. To request confidential communications, you must complete and sign a form available by contacting us at the address or phone number listed at the end of this notice.
Right to Inspect and Copy. Subject to the following exceptions, you have the right to inspect and/or obtain copies of your PHI that we maintain. This may include an electronic copy in certain circumstances if requested in writing. To request to inspect and copy your PHI, you must complete and sign a form available by contacting us.
Please note that you are not entitled to inspect and/or copy:- any psychotherapy notes
- any information compiled in anticipation of or for use in any civil, criminal or administrative action or proceeding;
- any information not subject to disclosure under the Clinical Laboratory Improvements Amendments 1988 (42 U.S.C. § 263a)
- certain other records as specified in the HIPAA Privacy Rule.
We may deny your request to inspect and copy your PHI in certain limited circumstances. If you are denied access to your information, you may request that the denial be reviewed. A licensed health care professional chosen by us will review your request and the denial. The person performing this review will not be the same one who denied your initial request. Under certain conditions, our denial will not be reviewable. In this event, we will inform you that the decision is not reviewable. We reserve the right to charge a reasonable copying fee for the cost of producing and mailing the documents. For more information on our fee structure and to obtain the designated form for your request, please contact us at the address or phone number listed at the end of this notice.
Right to Request Amendment of PHI. You have the right to request that we amend (make changes to) your PHI. Your request must clearly state the information to be amended and the reasons for doing so. We may deny your request if:
- we did not create the PHI
- we do not maintain the PHI
- the PHI is not available for inspection; or
- we believe the PHI is accurate and complete.
We will respond to your request within 60 days of receipt of your request. If we are unable to complete the request within the time required, we will notify you in writing that an extension of 30 days is needed. All requests must be in writing using a form obtained by calling or writing to us. Our contact information may be found at the conclusion of this document.
Right to Receive an Accounting of Certain Disclosures. You have the right to receive a summary of all instances in which we disclosed your PHI for purposes other than treatment, payment, health care operations and certain other activities. Your accounting will be provided to you within 60 days of our receipt of your request, unless we notify you in writing that a 30-day extension is needed. If you make a request more than once in a 12-month period, we may charge a reasonable, cost-based fee for additional copies. All requests must be in writing on the designated Blue Cross and Blue Shield of Nebraska form. You must complete and sign the form before we can process your request. For more information on our fee structure and to obtain the proper form for your request, please contact us at the address or phone number listed at the end of this Notice.
Right to Receive a Paper Copy. You are entitled to receive this notice in paper form. To do so, please contact us at the address or phone number listed at the end of this Notice.
Breach Notification. In the event of a breach of your unsecured PHI, we will provide you notification of such a breach as required by law or as we otherwise deem appropriate.
Complaints
If you believe your privacy rights have been violated, you may file a written complaint with us or you may submit a written complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.
You can receive a copy of our complaint form by notifying us at the address or phone number listed at the end of this notice. We will respond to your complaint within 60 days of receipt of the form. All complaints must be in writing using the designated Blue Cross and Blue Shield of Nebraska form.
Contact Information
If you have any questions regarding this Notice or would like more information on how to exercise your rights, please contact our Privacy Office at:
Blue Cross and Blue Shield of Nebraska
Attention: Privacy Office
P.O. Box 3248
Omaha, NE 68180-0001
Telephone Number: (402) 343-3521
Toll Free Number: (877) 258-3999
INDEPENDENT LICENSEE
Blue Cross and Blue Shield of Nebraska, Inc. is an independent licensee of the Blue Cross Blue Shield Association.
- Member Rights and Responsibilities
To review the Rights and Responsibilities policy, visit NebraskaBlue.com/Rights
Discrimination is Against the Law
Blue Cross and Blue Shield of Nebraska complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Blue Cross and Blue Shield of Nebraska does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Blue Cross and Blue Shield of Nebraska:
- Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats, other formats)
- Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
If you need these services, contact Member Services at 888-488-9850, TTY 711 between 8 a.m. to 9 p.m., Central time, seven days a week from Oct. 1 through March 31; 8 a.m. to 9 p.m., Central time, Monday through Friday April 1 through Sept. 30.
If you believe that Blue Cross and Blue Shield of Nebraska has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
Manager, Medicare Compliance
Blue Cross and Blue Shield of Nebraska
P.O. Box 3248
Omaha, NE 68180-0001
888-488-9850, TTY: 711
CivilRights@NebraskaBlue.com
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our Manager, Corporate Compliance, is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at hhs.gov/sites/default/files/ocr-cr-complaint-form-package.pdf. For quick processing, use the OCR online portal to file a complaint.
Multi-language Interpreter Services
English: We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at 1-888-488-9850 (TTY: 711). Someone who speaks English/Language can help you. This is a free service.
Spanish: Tenemos servicios de intérprete sin costo alguno para responder cualquier pregunta que pueda tener sobre nuestro plan de salud o medicamentos. Para hablar con un intérprete, por favor llame al 1-888-488-9850 (TTY: 711). Alguien que hable español le podrá ayudar. Este es un servicio gratuito.
Chinese Mandarin: 我们提供免费的翻译服务，帮助您解答关于健康或药物保险的任何疑 问。如果您需要此翻译服务，请致电 1-888-488-9850 (TTY: 711)。我们的中文工作人员很乐意帮助您。 这是一项免费服务。
Chinese Cantonese: 您對我們的健康或藥物保險可能存有疑問，為此我們提供免費的翻譯 服務。如需翻譯服務，請致電 1-888-488-9850 (TTY: 711)。我們講中文的人員將樂意為您提供幫助。這 是一項免費服務。
Tagalog: Mayroon kaming libreng serbisyo sa pagsasaling-wika upang masagot ang anumang mga katanungan ninyo hinggil sa aming planong pangkalusugan o panggamot. Upang makakuha ng tagasaling-wika, tawagan lamang kami sa 1-888-488-9850 (TTY: 711). Maaari kayong tulungan ng isang nakakapagsalita ng Tagalog. Ito ay libreng serbisyo.
French: Nous proposons des services gratuits d'interprétation pour répondre à toutes vos questions relatives à notre régime de santé ou d'assurance-médicaments. Pour accéder au service d'interprétation, il vous suffit de nous appeler au 1-888-488-9850 (TTY: 711). Un interlocuteur parlant Français pourra vous aider. Ce service est gratuit.
Vietnamese: Chúng tôi có dịch vụ thông dịch miễn phí để trả lời các câu hỏi về chương sức khỏe và chương trình thuốc men. Nếu quí vị cần thông dịch viên xin gọi 1-888-488-9850 (TTY: 711) sẽ có nhân viên nói tiếng Việt giúp đỡ quí vị. Đây là dịch vụ miễn phí .
German: Unser kostenloser Dolmetscherservice beantwortet Ihren Fragen zu unserem Gesundheits- und Arzneimittelplan. Unsere Dolmetscher erreichen Sie unter 1-888-488-9850 (TTY: 711). Man wird Ihnen dort auf Deutsch weiterhelfen. Dieser Service ist kostenlos.
Korean: 당사는 의료 보험 또는 약품 보험에 관한 질문에 답해 드리고자 무료 통역 서비스를 제공하고 있습니다. 통역 서비스를 이용하려면 전화 1-888-488-9850 (TTY: 711)번으로 문의해 주십시오. 한국어를 하는 담당자가 도와 드릴 것입니다. 이 서비스는 무료로 운영됩니다.
Russian: Если у вас возникнут вопросы относительно страхового или медикаментного плана, вы можете воспользоваться нашими бесплатными услугами переводчиков. Чтобы воспользоваться услугами переводчика, позвоните нам по телефону 1-888-488-9850 (TTY: 711). Вам окажет помощь сотрудник, который говорит по-pусски. Данная услуга бесплатная.
Arabic: إننا نقدم خدمات المترجم الفوري المجانية للإجابة عن أي أسئلة تتعلق بالصحة أو جدول الأدوية لدينا. للحصول على مترجم فوري، ليس عليك سوى الاتصال بنا على 9850-488-888-(TTY: 711) 1. سيقوم شخص ما يتحدث العربية .بمساعدتك. هذه خدمة مجانية
Hindi: हमारे स्वास्थ्य या दवा की योजना के बारे में आपके किसी भी प्रश्न के जवाब देने के लिए हमारे पास मुफ्त दुभाषिया सेवाएँ उपलब्ध हैं. एक दुभाषिया प्राप्त करने के लिए, बस हमें 1-888-488-9850 (TTY: 711) पर फोन करें. कोई व्यक्ति जो हिन्दी बोलता है आपकी मदद कर सकता है. यह एक मुफ्त सेवा है.
Italian: È disponibile un servizio di interpretariato gratuito per rispondere a eventuali domande sul nostro piano sanitario e farmaceutico. Per un interprete, contattare il numero 1-888-488-9850 (TTY: 711). Un nostro incaricato che parla Italianovi fornirà l'assistenza necessaria. È un servizio gratuito.
Portugués: Dispomos de serviços de interpretação gratuitos para responder a qualquer questão que tenha acerca do nosso plano de saúde ou de medicação. Para obter um intérprete, contacte-nos através do número 1-888-488-9850 (TTY: 711). Irá encontrar alguém que fale o idioma Português para o ajudar. Este serviço é gratuito.
French Creole: Nou genyen sèvis entèprèt gratis pou reponn tout kesyon ou ta genyen konsènan plan medikal oswa dwòg nou an. Pou jwenn yon entèprèt, jis rele nou nan 1-888-488-9850 (TTY: 711). Yon moun ki pale Kreyòl kapab ede w. Sa a se yon sèvis ki gratis.
Polish: Umożliwiamy bezpłatne skorzystanie z usług tłumacza ustnego, który pomoże w uzyskaniu odpowiedzi na temat planu zdrowotnego lub dawkowania leków. Aby skorzystać z pomocy tłumacza znającego język polski, należy zadzwonić pod numer 1-888-488-9850 (TTY: 711). Ta usługa jest bezpłatna.
Japanese: 当社の健康 健康保険と薬品 処方薬プランに関するご質問にお答えするため に、無料の通訳サービスがありますございます。通訳をご用命になるには、1-888-488-9850 (TTY: 711)にお電話ください。日本語を話す人 者 が支援いたします。これは無料のサー ビスです。