Notice of Privacy Practices

Federated Mutual Insurance Company - Health Insurance Division

Your information. Your rights. Our responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Please review this notice carefully.

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 PHI contained in a “designated record set”. This includes enrollment, payment, billing, claims adjudication and case or medical management record systems maintained by or for a health plan. Ask us how to do this.
• We will provide a copy or a summary of your PHI, usually within 30 days of the request. We may charge a reasonable, cost-based fee.

Ask us to correct health and claims records

• You can ask us to correct your PHI records if you think they are incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we will 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 share or use certain PHI for treatment, payment or our operations.
• We are not required to agree to your request, and we may say “no” if it would affect your care.

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 PHI for six years prior to the date you ask, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but we may charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this 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 using the contact information at the end of this notice.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by calling 1-877-696-6775; or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints/ or by sending a letter to: Secretary, US Dept of HHS, 200 Independence Ave., SW, Washington, D.C. 20201.
• 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, tell us 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 or 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 think it is in your best interest. We may also share your information when needed to lessen a serious or 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

Our Uses and Disclosures

How do we use or share your health information? The Plan contracts with business associates for certain services related to the Plan. PHI about you may be disclosed to the business associates so that they can perform contracted services. To protect your PHI, the business associate is required, by law and by contract, to appropriately safeguard the health information. The following categories describe the different ways in which the Plan and its business associates may use and disclose your PHI. We typically use or share your health information in the following ways.

Help manage the health care treatment you receive

• We can use your health information and share it with professionals who are treating you.

Example: We give your cardiologist the name of your treating doctor so the cardiologist can get lab results from your treating doctor.

Run our organization

• We can use and disclose your information to run our organization and contact you when necessary.

Example: We use health information to develop better services for you.

We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long-term care plans.

Pay for your health services

• We can use and disclose your health information as we pay for your health services.

Example: We share information about you with your doctor regarding your eligibility for coverage.

Administer your plan

• We may disclose your health information to your health plan sponsor for plan administration.

Example: We provide the plan sponsor with certain statistics to explain the premiums being charged.

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.

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 are complying with federal privacy laws.

Respond to organ and tissue donation requests and work with a medical examiner or funeral director

• We can share health information about you with organ procurement donation organizations.
• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

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 subpoena.

Additional information

• If your state has more stringent laws that apply to your health information, we will comply with those state laws.
• We never market or sell your health information.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• 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: 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 or provide a copy to you.

Contact Information

If you would like general information about your privacy rights or would like a copy of this notice, go to: http://www.federatedinsurance.com.

If you have specific questions about your rights or about this notice, you may contact us:

• Call us at 1-507-455-5200 or 800-533-0472 and ask to speak to the Privacy Officer.
• Write us at:

Federated Mutual Insurance Company
Attn: Privacy Officer for the Plan
121 East Park Square
Owatonna, MN 55060

Effective Date of this Notice

September 23, 2013
Amended: January 1, 2018