» Right to Request Restrictions : You have the right to request a restriction or limitation on the PHI we use or disclose for treatment ,
payment or health care operations . In addition , you have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment of your care , like a family member or friend . For example , you could ask that we not disclose your PHI to your spouse . To request a restriction , you must make your request , in writing , to the Privacy Officer . We are not required to agree to your request . If we do agree , we will comply with your request unless the information is needed to disclose the information in certain emergency treatment situations . In addition , you have the right to restrict disclosure of PHI to the health plan for payment or healthcare operations ( but not for carrying out treatment ) in situations where you have paid the healthcare provider out-of-pocket in full . In this case , we are required to implement the restrictions that you request .
» Right to Request Confidential Communications : You have the right to request that we communicate with you about medical
matters in a certain way or at certain locations . For example , you can ask that you be contacted only at work or by mail . To request confidential communications , you must make your request , in writing , to the Privacy Officer . Your request must specify how or where you wish to be contacted . We will accommodate all reasonable requests .
» Right to a Paper Copy of This Notice : You have the right to a paper copy of this notice . You may ask for a paper copy of this notice at any time by contacting the Privacy Officer .
Privacy Officer
Questions , concerns or complaints about the privacy of PHI should be directed to the following :
Human Resources Department 257 East 200 South – 9th Floor Salt Lake City , UT 84111
Complaints
If you believe your privacy rights have been violated , you may file a complaint with HRCentral ’ s Privacy Officer or with the Secretary of the Department of Health and Human Services . To file a complaint with HRCentral ’ s Privacy Officer , please direct correspondence to :
Human Resources Department 257 East 200 South – 9th Floor Salt Lake City , UT 84111
To file a complaint with the Department of Health and Human Services , please direct correspondence to :
DHHS , Office for Civil Rights Hubert H . Humphrey Building Mail Stop 506F 200 Independence Avenue , SW Washington , DC 20211 Phone : 202.205.8725 or Email : OCRComplaint @ hhs . gov
All complaints , whether submitted to the HRCentral Privacy Officer or the Department of Health and Human Services , must be made in writing .
You will not be penalized or otherwise retaliated against for filing a complaint .
Changes to This Notice
HRCentral may change the terms of this notice and privacy policies at any time . The revised or changed policies will be effective for all PHI maintained at that time , as well as for PHI received in the future .
Family Status Changes
As outlined in Internal Revenue Code Section 125 , HRCentral offers health care benefits on a tax-free basis . You do not pay federal or state income taxes , or Social Security taxes on the per pay contributions for these benefits . However , because of the tax advantages of tax-free contributions , the Internal Revenue Service ( IRS ) imposes certain restrictions .
After you enroll — either when you are first eligible or during the annual Open Enrollment period — you may not make changes to your benefits until the next Open Enrollment period . The only exception to this rule is if you experience an IRS-qualifying life status change .
IRS-qualifying life status changes include :
» Your marriage , divorce , or annulment ;
» Birth , adoption , placement for adoption , or appointment of legal guardianship of a child ;
» Your death or the death of your covered dependent ;
» Your or your dependent ’ s loss or gain of employment ;
» A change in your or your dependent ’ s employment status due to a switch from full-time to part-time or part-time to full-time ;
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