THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY

BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS

INFORMATION. PLEASE REVIEW IT CAREFULLY.

Under federal and State law, the City of Baltimore, Employee Benefits Division (EBD), which administers the

City of Baltimore Employees and Retirees Health Benefits Program (the Program), protects the privacy of your

protected health information. EBD takes steps to ensure that your protected health information is kept secure and

confidential and is used only when necessary to administer the Program. EBD is required to give you this notice

to tell you how EBD may use and give out (“disclose”) your protected health information held by EBD. This

information generally comes to EBD from you when you enroll in a health plan and from your health plan in the

administration of the Program.

Your health plan in the Program (for example, the CareFirst Blue Cross Blue Shield PPO or the UnitedHealthcare

POS) will also use and disclose your personal health information. For questions about your health plan’s policies

and procedures and to exercise your rights regarding your protected health information held by your health plan,

please contact your health plan directly.

EBD has the right to use and disclose your protected health information to administer the Program. For example,

EBD will use and disclose your protected health information:

            behalf asks for our assistance regarding a benefit or customer service issue. EBD may need a written

            authorization from you for your health plan to discuss your case.

          • To determine your eligibility for benefits and to administer your enrollment in your chosen health plan.

            pharmacies and others for services delivered to you that are covered by your health plan, to coordinate

            your benefits with other benefit plans (including workers’ compensation plans or Medicare), or to make

            premium payments.

            denied claims.

            to procure health benefit plans offered through the Program.

          • To investigate fraud in Program enrollment.

             someone other than you to discuss your protected health information with EBD, please contact EBD to

             complete an authorization form.

             actions.

Where required by law, such as in response to a subpoena for records, to the Secretary of the federal

Department of Health and Human Services.

          • When an authorization signed by you is presented to EBD for disclosure of the records.

          • For healthcare oversight activities (such as fraud and abuse investigations).

          • To avoid a serious and imminent threat to health or safety.

            By law, EBD must have your written permission (an “authorization”) to use or give out your protected health

            information for other purposes. You may take back your written permission at any time, except if EBD has

            already acted based on your permission.

By law, you have the right to:

          • Make a written request and see or get a copy of your protected health information held by EBD.

            information is missing, and EBD agrees. If EBD disagrees, you may have a statement of your

            disagreement added to your protected health information.

            years prior to your request. The listing will not cover your protected health information that was used or

            disclosed for treatment, health care operations or payment purposes, given to you or your personal

            representative, disclosed pursuant to an authorization, or was disclosed prior to April 14, 2003.

            by sending materials to a P.O. Box instead of your home address) if using your address on file creates a

            danger to you.

            may not be able to agree to your request if the information is used for treatment, payment or to conduct

            operations in the manner described above or if a disclosure is required by law.

For more information on exercising your rights set out in this notice, you may call 410-396-5830 and ask for

EBD’s Program privacy official for this purpose. If you believe EBD has violated your privacy rights set out in

this notice, you may file a written complaint with EBD at the following address:

City of Baltimore

Employee Benefits Division

Room 500, 201 East Baltimore Street

Baltimore, MD 21202

Filing a complaint will not affect your benefits under the Program. You also may file a complaint with the

Secretary of the federal Department of Health and Human Services at:

Department of Health and Human Services Office of Civil Rights

150 South Independence Mall West, Suite 372

Public Ledger Building

Philadelphia, PA 19106-9111

EBD has the right to change the way your protected health information is used and given out. If EBD makes any

             changes, you will get a new notice. The privacy practices listed in this notice have been effective since April 14, 2003.