Health Information Privacy and Data Security
Please Read This Carefully
This section describes how medical information about you may be used and disclosed and how you can obtain access to this information.
The Pacific Gas and Electric Company and its health plan partners are committed to protecting the privacy and confidentiality of the health information for eligible participants (including eligible employees, retirees and surviving spouses, and their Eligible Dependents) that is created or received in the administration of The Pacific Gas and Electric Company Health Care Plan for Active Employees, The Pacific Gas and Electric Company Health Care Plan for Retirees and Surviving Dependents, and The Pacific Gas and Electric Company Health Care Flexible Spending Account Plan (collectively, "Health Plans").
Federal legislation known as the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and the underlying privacy and security regulations issued by the U.S. Department of Health and Human Services provide additional protection for individually identifiable health information (referred to as "Protected Health Information"). The privacy regulations were effective April 14, 2004, and the security regulations were effective April 20, 2005. Protected Health Information includes health information in any form or medium including paper, oral communications and electronic media. For this purpose, electronic media will include health information stored on computer hard drives, any removable/transportable digital memory medium, such as a magnetic tape or disk, optical disk, or digital memory card, as well as the various methods in which health information is transmitted electronically.
The Health Plans will not use or disclose an eligible participant's Protected Health Information, except as necessary for purposes of treatment, payment or health care operations, or as otherwise permitted by applicable law. The Health Plans may also disclose an eligible participant's Protected Health Information to authorized Pacific Gas and Electric Company personnel (including personnel at affiliated companies whose employees participate in the Health Plans) for these and other administrative purposes. Neither the Pacific Gas and Electric Company nor its authorized personnel will, without the eligible participant's written authorization, use or disclose his or her Protected Health Information for employment-related actions and decisions, or in connection with any other benefit or employee benefit plan sponsored by the Pacific Gas and Electric Company.
Under HIPAA, eligible participants have certain important rights with respect to Protected Health Information, including the rights to inspect and copy information, receive an accounting of certain disclosures of health information, and under certain circumstances, amend the information that is incorrect or incomplete. Eligible participants may also request a restriction on the Protected Health Information that the Health Plans use or disclosure about their treatments, payments or health care operations, or that the Health Plans communicate with them about health matters using alternative means or at alternative locations. Eligible participants also have the right to file a complaint with the Health Plans or with the U.S. Department of Health and Human Services if they believe that their health information rights under HIPAA have been violated.
The Health Plans maintain a "HIPAA Notice of Health Information Privacy Practices" ("HIPAA Notice") that provides a description of how Pacific Gas and Electric Company and the Health Plans may use or disclose Protected Health Information, as well as eligible participants' health information rights under HIPAA. The Health Plans have implemented administrative, physical and technical safeguards designed to protect the confidentiality, integrity and availability of any Protected Health Information that it transmits, receives or maintains in any form of electronic media.
To receive more information about the Health Plans' health information privacy practices or HIPAA rights, or if you have any questions about the HIPAA Notice, you may contact the Pacific Gas and Electric Company Plan Administrator, PG&E HR Service Center, 1850 Gateway Blvd, 7th Floor, Concord, CA 94520.
Health Information Privacy
This Notice is required by the Health Insurance Portability and Accountability Act ("HIPAA") and is intended to describe to the extent applicable to you how the Pacific Gas and Electric Company Health Care Plan for Active Employees, the Pacific Gas and Electric Company Health Care Plan for Retirees and Surviving Dependents, and the Pacific Gas and Electric Company Health Care Flexible Spending Account Plan (collectively, "Health Plans"), and the various health plan vendors that administer these Health Plans (for example, Anthem Blue Cross) will protect your health information. This Notice also describes your rights to access and control your protected health information.
"Health information" for this purpose means information that identifies you and either relates to your physical or mental health condition or the provision of health care to you, or relates to the payment of your health care expenses. This individually identifiable health information is known as "protected health information" ("PHI"). Your PHI will not be used or disclosed by the Health Plans without a written authorization from you, except as described in this Notice or as otherwise permitted by federal or state health information privacy laws. Please note that your personal physician or other health care facilities (for example, hospitals or health clinics) where you may receive health care or treatment may have different policies, procedures or notices regarding the physician's or health care facility's use or disclosure of PHI that they may have created. These health care providers and any health plan insurer will separately notify you regarding their health information policies or procedures.
Health Plan Privacy Obligations
The Health Plans are required by law to:
  • Make sure that health information that identifies you is kept private;
  • Give you this Notice of their legal duties and privacy practices with respect to health information about you; and
  • Follow the terms of the Notice that are in effect.
How the Health Plans May Use and Disclose Health Information About You
The Health Plans may use health information or disclose it amongst themselves or to others for a number of different reasons. The following are the different ways that the Health Plans may use and disclose your PHI without your authorization:
  • For Treatment. The Health Plans may disclose your PHI to a health care provider who provides, coordinates or manages health care treatment on your behalf. For example, if you are unable to provide your medical history as a result of an accident, the Health Plans may advise an emergency room physician about the different medications that you may have been prescribed.
  • For Payment. The Health Plans may use and disclose your PHI so claims for health care treatment, services, and supplies that you receive from health care providers may be paid according to the Health Plans' terms. The Health Plans may also use your PHI for billing, reviews of health care services received, and subrogation. For example, the Health Plans may tell a doctor or hospital whether you are eligible for coverage or what percentage of the bill will be paid by the Health Plans. Another example is that the Plans may share information about your coverage or the expenses you have incurred with another health plan to coordinate payment of benefits.
  • For Health Care Operations. The Health Plans may use and disclose your PHI to enable them to operate more efficiently or to make certain that all of their participants receive the appropriate health benefits. For example, the Health Plans may use your PHI for wellness programs, case management, to refer individuals to disease management programs, for underwriting, premium rating, activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits, to arrange for medical reviews, or to perform population-based studies designed to reduce health care costs. In addition, the Health Plans may use or disclose your PHI to conduct compliance reviews, audits, legal reviews, actuarial studies, and/or for fraud and abuse detection. The Health Plans may not use or disclose genetic information for underwriting purposes.
  • To The Plan Sponsor. The Health Plans are sponsored by the Company. The Health Plans may disclose your PHI to designated personnel at the Company so that they can carry out related administrative functions, including the uses and disclosures described in this Notice. Such disclosures will be made only to the individuals authorized to receive such information under the Health Plans. These individuals will protect the privacy of your health information and ensure that it is used only as described in this Notice or as permitted by law. Unless authorized by you in writing, your health information: (1) may not be disclosed by the Health Plans to any other employee or department of the Company, and (2) will not be used by the Company for any employment-related actions or decisions, or in connection with any other employee benefit plans sponsored by the Company.
  • To a Business Associate. Certain services are provided to the Health Plans by third-party administrators known as "business associates." For example, the Health Plans may place information about your health care treatment into an electronic claims processing system maintained by a business associate so that your claim may be paid. In so doing, the Health Plans will disclose your PHI to their business associates so that the business associates can perform their claims payment functions. However, the Health Plans will require their business associates, through written agreements, to appropriately safeguard your health information in the same way as the Health Plans are required to do under HIPAA.
  • For Treatment Alternatives. The Health Plans may use and disclose your PHI to tell you about possible treatment options or health care alternatives that may be of interest to you.
  • For Health-Related Benefits and Services. The Health Plans may use and disclose your PHI to tell you about health-related benefits or services that may be of interest to you.
  • To Communicate With Family and Others When You Are Not Present. There may be times when a family member or other person involved in your or your child's care contacts the Health Plans on your behalf because there is an emergency, you are not present, or you lack the decision making capacity to agree or object. In those instances, we will use our best judgment to determine if the disclosure of your or your child's PHI is warranted. If so, we will limit the disclosure to the PHI that is directly relevant to the person's involvement with your or your child's health care. For example, if you are hospitalized, we may provide your spouse with information about payment of your medical claims. The Health Plans may also advise a family member or close friend about your condition, your location (for example, that you are in the hospital), or death, unless other laws would prohibit such disclosures.
  • As Required by Law. The Health Plans will disclose your PHI when required to do so by federal, state, or local law, including those laws that require the reporting of certain types of wounds, illnesses or physical injuries, or the reporting of information to the U.S. Department of Health and Human Services or its designee.
Special Use and Disclosure Situations
The Health Plans may also use or disclose your PHI without your authorization under the following circumstances:
  • Lawsuits and Disputes. If you become involved in a lawsuit or other legal action, the Health Plans may disclose your PHI in response to a court or administrative order, a subpoena, warrant, discovery request, or other forms of lawful due process.
  • Law Enforcement. The Health Plans may release your PHI if asked to do so by a law enforcement official, for example, to report child abuse, to identify or locate a suspect, material witness or missing person, or to report a crime, the crime's location or victims, or the identity, description, or location of the person who committed the crime.
  • Workers' Compensation. The Health Plans may disclose your PHI to the extent authorized by and to the extent necessary to comply with workers' compensation laws and other similar programs.
  • Military and Veterans. If you are or become a member of the U.S. Armed Forces, the Health Plans may release medical information about you as deemed necessary by military command authorities.
  • To Avert Serious Threat to Health or Safety. The Health Plans may use and disclose your PHI when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person.
  • Public Health Risks. The Health Plans may disclose health information about you for public health activities. These activities include preventing or controlling disease, injury or disability; reporting births and deaths; reporting child abuse or neglect; reporting reactions to medications or problems with medical products; or to notify people of recalls of products they have been using.
  • Health Oversight Activities. The Health Plans may disclose your PHI to a health oversight agency for audits, investigations, inspections, and licensure necessary for the government to monitor the health care system and government programs.
  • Research. Under certain limited circumstances, the Health Plans may use and disclose your PHI for medical research purposes.
  • National Security, Intelligence Activities, and Protective Services. The Health Plans may release your PHI to authorized federal officials: (1) for intelligence, counterintelligence, and other national security activities authorized by law; and (2) to enable them to provide protection to the members of the U.S. government or foreign heads of state, or to conduct special investigations.
  • Organ and Tissue Donation. If you are an organ donor, the Health Plans may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation, or to an organ donation bank to facilitate organ or tissue donation and transplantation.
  • Coroners, Medical Examiners, and Funeral Directors. The Health Plans may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. The Health Plans may also release your PHI to a funeral director, as necessary, to carry out his/her responsibilities.
Your Rights Regarding Your Health Information
Except as described in this notice, other uses and disclosures will be made only with your prior written authorization. For example, the Health Plans will never sell your health information unless you have authorized us to do so. If a written authorization is obtained, you may revoke your authorization as allowed under the HIPAA rules. However, you cannot revoke your authorization with respect to any disclosures the Health Plans have already made.
You have the following rights regarding the health information that the Health Plans maintain about you:
  • Right to Inspect and Copy Your Personal Health Information. You have the right to inspect and copy your PHI that is maintained in a "designated record set" for so long as the Health Plans maintain your PHI. A "designated record set" includes medical information about eligibility, enrollment, claim and appeal records, medical and billing records maintained by the Health Plans, and records used in whole or in part to make decisions about your Health Plan benefits, but does not include psychotherapy notes, information intended for use in a civil, criminal or administrative proceeding, or any information to which access is otherwise prohibited by law.
To inspect and copy health information maintained by the Health Plans, submit your request in writing to:
Pacific Gas and Electric Company
Plan Administrator — HIPAA
PG&E Benefits Department
1850 Gateway Blvd., 7th Floor
Concord, CA 94520
The Health Plans may charge a fee for the cost of copying and/or mailing your request. The Health Plans must act upon your request for access no later than 30 days after receipt (60 days if the information is maintained off-site). A single, 30-day extension is allowed if the Health Plans are unable to comply by the initial deadline. In limited circumstances, the Health Plans may deny your request to inspect and copy your PHI. Generally, if you are denied access to your health information, you will be informed as to the reasons for the denial, and of your right to request a review of the denial.
You may also request your health information be sent to another entity or person, so long as that request is clear, conspicuous and specific. If the Health Plans do not maintain the health information but knows where it is maintained, you will be informed of where to direct your request.
If the Health Plans keep your records in an electronic format, you may request an electronic copy of your health information if in a form and format readily producible by the Health Plans. If the information is not in a form and format readily producible by the Health Plans, the Health Plans will work with you to come to an agreement on form and format. If we cannot agree on an electronic form and format, the Health Plans will provide you with a paper copy. You may also request that such electronic health information be sent to another entity or person, so long as that request is clear, conspicuous and specific. Any charge that is assessed to you for these copies, if any, will be reasonable and based on the Health Plan's costs.
  • Right to Amend Your Personal Health Information. If you feel that the health information that the Health Plans have about you is incorrect or incomplete, you may ask the Health Plans to amend it. You have the right to request an amendment for so long as the Health Plans maintain your PHI in a designated record set.
To request an amendment, send a detailed request in writing to:
Pacific Gas and Electric Company
Plan Administrator — HIPAA
PG&E Benefits Department
1850 Gateway Blvd., 7th Floor
Concord, CA 94520
You must provide the reason(s) to support your request. The Health Plans may deny your request if you ask the Health Plans to amend health information that was: (1) accurate and complete; (2) not created by the Health Plans; (3) not part of the health information kept by or for the Health Plans; or (4) not information that you would be permitted to inspect and copy. The Health Plans have 60 days after the request is received to act on the request. A single, 30-day extension is allowed if the Health Plans cannot comply by the initial deadline. If the request is denied, in whole or in part, the Health Plans will provide you with a written denial that explains the basis for the denial. You may then submit a written statement disagreeing with the denial and, if permitted under HIPAA, have that statement included with any future disclosures of your PHI.
  • Right to an Accounting of Disclosures. You will be notified of any unauthorized access, use or disclosure of your unsecured information as required by law. In addition, you have the right to request an "accounting of disclosures" of your PHI. This is a list of disclosures of your PHI that the Health Plans have made to others for the six (6) year period prior to the request, except for those disclosures necessary to carry out treatment, payment, or health care operations, disclosures previously made to you, disclosures that occurred prior to April 14, 2003 (the HIPAA compliance date), or disclosures made in certain other situations described under HIPAA.
To request an accounting of disclosures, submit your request in writing to:
Pacific Gas and Electric Company
Plan Administrator — HIPAA
PG&E Benefits Department
1850 Gateway Blvd., 7th Floor
Concord, CA 94520
Your request must state a time period for the accounting, which may not be longer than six (6) years prior to the date the accounting was requested. If the accounting cannot be provided within 60 days, an additional 30 days is allowed if the Health Plans provide you with a written statement of the reasons for the delay and the date by which the accounting will be provided. If you request an accounting more than once within a 12-month period, the Health Plans will charge a reasonable, cost-based fee for each subsequent accounting.
  • Right to Request Restrictions. You have the right to request a restriction on the health information that the Health Plans use or disclose about you for treatment, payment, or health care operations. You also have the right to request that the Health Plans limit the individuals (for example, family members) to whom the Health Plans disclose health information about you. For example, you could ask that the Health Plans not use or disclose information about a surgical procedure that you had. While the Health Plans will consider your request, they are not required to agree to it. If the Health Plans agree to the restriction, they will comply with your request until such time as the Health Plans provide written notice to you of their intent to no longer agree to such restriction, or unless such disclosure is required by law.
To request a restriction or limitation, make your request in writing to:
Pacific Gas and Electric Company
Plan Administrator — HIPAA
PG&E Benefits Department
1850 Gateway Blvd., 7th Floor
Concord, CA 94520
In your request, you must state: (1) what information you want to limit; (2) whether you want to limit the Health Plans' use, disclosure, or both; and (3) to whom you want the limit(s) to apply. Note: The Health Plans are not required to agree to your request.
Certain other entities covered by these HIPAA rules (such as your health care provider or its business associate), but not the Health Plans, must comply with your request that health information regarding a specific health care item or service not be disclosed to the Health Plans for purposes of payment or health care operations, if you have paid for the item or service in full out of pocket.
  • Right to Request Confidential Communications. You have the right to request that the Health Plans communicate with you about health matters using alternative means or at alternative locations. For example, you can ask that the Health Plans send your explanation of benefits ("EOB") forms about your benefit claims to a specified address. To request confidential communications, make your request in writing to:
Pacific Gas and Electric Company
Plan Administrator — HIPAA
PG&E Benefits Department
1850 Gateway Blvd., 7th Floor
Concord, CA 94520
The Health Plans will make every attempt to accommodate all reasonable requests. Your request must specify how or where you want to be contacted.
  • State Privacy Rights. You may have additional privacy rights under state laws, including rights in connection with mental health and psychotherapy reports, pregnancy, HIV/AIDS-related illnesses, and the health treatment of minors.
  • Right to a Paper Copy of this Notice. You have the right to a paper copy of this Notice upon request. This right applies even if you have previously agreed to accept this Notice electronically. To request a written copy of this Notice at any time, you may write to:
Pacific Gas and Electric Company
Plan Administrator — HIPAA
PG&E Benefits Department
1850 Gateway Blvd., 7th Floor
Concord, CA 94520
Changes to this Privacy Notice
The Health Plans reserve the right to change this Notice at any time and from time to time, and to make the revised or changed Notice effective for health information that the Health Plans already have about you, as well as any information that the Health Plans may receive in the future. The revised Notice will be provided to you in the same manner as this Notice, or electronically if you have consented to receive the Notice electronically or you are able to receive electronic information at your worksite, in a manner consistent with federal regulations.
Complaints
If you believe that your health information privacy rights, as described under this Notice, have been violated, you may file a written complaint with the Health Plans by contacting the person listed at the address under "Contact Information," below. You may also file a written complaint directly with the Secretary of the U.S. Department of Health and Human Services, at the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, Hubert H. Humphrey Building, Washington, D.C. 20201. The complaint should generally be filed within 180 days of when the act or omission complained of occurred. Note: You will not be penalized or retaliated against for filing a complaint.
Other Uses and Disclosures of Health Information
Other uses and disclosures of health information not covered by this Notice or by the laws that apply to the Health Plans will be made only with your written authorization. If you authorize the Health Plans to use or disclose your PHI, you may revoke the authorization, in writing, at any time. If you revoke your authorization, the Health Plans will no longer use or disclose your PHI for the reasons covered by your written authorization; however, the Health Plans will not reverse any uses or disclosures already made in reliance on your prior authorization.
Contact Information
To receive more information about the Health Plans' privacy practices or your rights, or if you have any questions about this Notice, please contact the Health Plans at the following address:
Health Plan Name(s)
Pacific Gas and Electric Company Health Care Plan for Active Employees, Pacific Gas and Electric Company Health Care Plan for Retirees and Surviving Dependents, Pacific Gas and Electric Company Health Care Flexible Spending Account Plan
Contact Person
HIPAA Privacy Official
Address
77 Beale Street, Mail Code B23H, San Francisco, CA 94105
Phone
(415) 973-0290
A copy of this Notice is available online from the Human Resources Forms section of the PG&E@Work intranet, or you can contact the PG&E Benefits Service Center at 866-271-8144 (open weekdays from 7:30 a.m. to 5 p.m. Pacific time).