HIPAA Notice of Privacy Practices



We at Elite Administration & Insurance Group, Inc have a legal duty to safeguard your protected health information. We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information in a responsible and professional manner. This notice describes how we may use and disclose your medical information and how you can get access to this information. It also describes your rights and our legal obligations with respect to your medical information. We abide by the terms of this notice. You have the right to request a paper copy of this notice. Please review it carefully. The term “Protected Health Information” (PHI) includes all information related to your past, present or future physical or mental health or to payment for health care. PHI includes information maintained by the Plan in oral, written or electronic form (ePHI). It is not necessary for you to take any action as a result of this notice unless you wish to exercise one or more of your rights as described below.

Effective: September 23, 2013


We may use and disclose your PHI for many reasons. Under some circumstances, we are allowed by law to use and disclose your PHI without your authorization. Under other circumstances, we need your authorization to use and disclose your PHI. Unless otherwise required by law, we use and disclose only the minimum amount of information necessary to satisfy the purpose of the use or disclosure. Described below are different categories of our uses and disclosures and some examples of each category.

Our privacy policies set out in this notice apply to your PHI whether your participation in the plan is active or has been terminated. In some cases, we are required by law to retain the PHI for a set amount of time. We will not destroy your PHI for that set amount of time, even if your coverage with us has been terminated. Therefore, even after your coverage terminates, your PHI may be used for many of the purposes described in this notice.


Written Authorization.   If you provide written authorization, we may disclose your PHI to the person you authorize. You may revoke this authorization at any time. Revoking your authorization will not affect any action that was taken before the authorization was revoked.

Oral Authorization.  Family members, friends or other persons may be assisting you with your healthcare. We may disclose your PHI to these family members, friends or others if you give us your oral authorization. If you are unable to give us your oral authorization, we may disclose your PHI to these family members, friends or others if there is a medical emergency or for disaster relief purposes to the extent we believe the disclosure of your PHI would be in your best interest to help with your health care or with payment for your health care.

Other Uses and Disclosures.  Your written authorization is required for all other uses and disclosures of your PHI that are not described in this notice.


Abuse or Neglect.  We may disclose your PHI to the appropriate authorities to report child abuse or neglect or when there is a concern that you have been a victim of abuse, neglect or domestic violence.

Business Associates.  We may share your PHI with other third parties who we hire for various business activities. These third parties also are required to keep your information private. These third parties may make sure that we are in compliance with laws that may affect us, or help us improve the quality of services we render.

Coroners, Funeral Directors and Organ Donations.  We may disclose PHI of deceased covered individuals or their family members to coroners or funeral directors so they can carry out their duties. In addition, we may disclose PHI to organizations that arrange organ donations and transplants.

Health Oversight.  We may disclose your PHI to health oversight agencies that are responsible for auditing, investigating, inspecting and licensing healthcare entities. These activities are necessary for the government to monitor the healthcare system, government programs and compliance with laws.

Health Related Benefits and Services.   We may use or disclose your PHI to contact you about health-related benefits and services.

Healthcare Operations.   We may use and disclose your PHI to operate our business and make sure that you receive quality care. For example, we may use or disclose your PHI for investigating fraud and abuse, responding to your inquiries, determining cost of coverage, determining your eligibility for coverage or for any purpose required by law.

Law Enforcement.  We may disclose your PHI to law enforcement officials in certain situations. For example, we may disclose PHI to help identify or locate a suspect, witness or missing person or to provide information concerning a crime.

Legal Proceedings.  We may disclose your PHI for legal proceedings if there is a court order, administrative order, subpoena, discovery request or other lawful process.

Marketing.  We will obtain an authorization from you before we use or disclose your PHI for marketing purposes.

Military Activity and National Security.  We may disclose the PHI of military personnel to military authorities under certain circumstances. For example, we may disclose your PHI in the event of a national security incident or for intelligence purposes.

Parental Access.  Generally, parents or guardians may receive their minor child’s PHI.

Payment.  We may use and disclose your PHI to provide proper payment for services that are covered under your benefit plan. For example, we may need to give your insurance information to medical services providers so they can bill us and receive payment for the treatment you received. We may also use and disclose your PHI to coordinate benefits with other insurance carriers, such as Medicare or your auto insurance carrier.

Plan Sponsors.  If you are enrolled in a health plan through your employer or other group entity, you are enrolled in a group health plan. If your plan sponsor (the person or group that established the group health plan) needs PHI to administer the group health plan, they are required by law to establish privacy procedures for receiving PHI from us, and they may use it only as the law allows. If your plan sponsor establishes these privacy procedures, we may disclose PHI to them.

Public Health and Safety.  We may disclose your PHI to government officials in charge of collecting information about public health, such as to prevent or reduce a serious threat to the health or safety of the public.

Required by Law. We may disclose your PHI when we are required to do so by law. For example, we must disclose your PHI to the U.S. Department of Health and Human Services officials upon their request so they can determine whether we are complying with federal privacy laws.

Research. We may disclose your PHI to researchers in limited situations. These researchers are required to establish measures to protect your privacy.

Treatment.  We may disclose your PHI to healthcare professionals who ask for it in order to treat you, to establish your eligibility for medical services requested.

Underwriting.  We may receive your PHI for underwriting, establishing premium contributions, or other activities relating to the creation, renewal or replacement of your benefit plan. We will not use or further disclose your PHI for any other purpose, except as required by Workers Compensation. We may disclose your PHI as required by workers compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.


Access.  You have the right to look at or get copies of your PHI in our control or possession, with limited exceptions. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You must make your request to obtain access to your PHI in writing. We may charge you a reasonable fee for the costs of your request, which may vary depending on the format requested, but may include copy and postage fees. If you prefer, we will prepare a summary or an explanation of your PHI for a fee.

Amendment.  You have the right to ask us to amend your PHI if you believe that it contains a mistake or that an important piece of information is missing. Your request must be in writing and must explain why the information should be amended. We may deny your request in certain cases. For example, we may deny your request if we did not create the information, such as medical information received from your doctor. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement that we will append to the PHI you wanted amended. We will ensure your statement of disagreement is included with all future disclosures we make of that PHI. If we accept your request to amend your PHI, we will make reasonable efforts to inform all relevant persons and entities of the amendment and to include the amendment in any future disclosures of that PHI.

Confidential Communications.  If you feel that you could be in danger as a result of your PHI being sent to your main address, you have the right to ask that we send your PHI to a different address or that we communicate with you in a certain way. You must make your request in writing and you must state that the PHI could endanger you if it is not communicated in confidence by the alternative means or at the alternative location you have requested. We will accommodate reasonable requests when possible.

Disclosure Accounting.  You have the right to ask us for a list of disclosures that we have made of your PHI. Your request may be for disclosures made up to six (6) years before the date of your request. We will provide you with a list of disclosures, including the date on which we made the disclosure, the name of the person or entity to whom we made the disclosure, a description of the PHI we disclosed and the reason for the disclosure. This list will not include

  • Disclosures for treatment, payment or healthcare operations
  • Disclosures to you or your legal representative
  • Disclosures that you or your legal representative authorized
  • Certain other disclosures as allowed by law

If you request this list more than once in a twelve (12) month period, we may charge you a reasonable cost-based fee for responding to these additional requests.

Electronic Notice.  If you receive this notice on our website or by e-mail, you also may ask for this notice in written form. Please contact us at the address listed at the end of this notice under the paragraph entitled “Questions and Complaints”.

Restrictions.  You have the right to ask us to restrict the way we use or disclose your PHI for treatment, payment and healthcare operations, as described above. However, you may not request that we restrict the uses and disclosures of your PHI that we are required or allowed to make by law. We will consider your request for restrictions, but we are not required by law to agree to them. If we agree to restrictions, we will follow them, except in an emergency situation. Any agreement we make to restrict our use or disclosure of your PHI must be in writing signed by a person authorized to make such an agreement on our behalf. We will not be bound to any agreement that is not in writing. We may terminate our agreement to restrict our uses and disclosures of your PHI upon notice to you. If you do not agree to the termination of the agreement, the termination is only effective with respect to your PHI created or received after we have informed you of our decision to terminate our agreement to restrict our use or disclosure of Questions and Complains. If you believe your privacy rights have been violated, you can file a complaint with us in writing at the address below. You may also file a complaint in writing with the Secretary of the U.S. Department of Health and Human Services in Washington, D.C. Filing a complaint will not negatively impact your status as an insured or the services you receive from us. We will treat your personal representative as you, except where prohibited by law.

PHI use and disclosure by the Plan is regulated by the federal Health Insurance Portability and Accountability Act, known as HIPAA. This notice attempts to summarize the regulations. The regulations will supersede this notice if there is any discrepancy between the information in this notice and the regulations.

If you have any questions regarding this notice or the subjects addressed in it, you may contact:

Privacy Officer
Elite Administration & Insurance Group, Inc.
1300 W. Higgins, Suite 208
Park Ridge, IL 60068