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Legal Notices and Forms

HIPAA

The Health Insurance Portability and Accountability Act was passed by Congress in 1996. This law helps to protect an employee's right to health coverage during events such as changing or losing jobs, pregnancy, moving or divorce. It also provides rights and protections for employers when obtaining and renewing health coverage for their employees.  The HIPAA's Privacy Rules became effective April 14, 2003. These were issued to provide protection against the unauthorized use and disclosure of an individual's Protected Health Information (PHI). The Department of Employee Insurance is adhering to these rules in order to protect the confidentiality of our members. PHI is defined as information that can be identified as belonging to a specific individual. This information can be transmitted or maintained in many ways such as, but not limited to, mail, fax, copier, telephone, email or paper mediums. Disclosure of PHI to anyone other tha​n the member is prohibited without the member's specific authorization to disclose.

Health Insurance and Health Flexible Spending information maintained by the Department of Employee Insurance may be disclosed to the member's spouse, dependent, or the member's legal counsel/representative if that member has completed an Authorization for Disclosure Form for the plan year and it has been received by the Department of Employee Insurance. If the member obtains legal counsel, the member will need to complete the Authorization for Disclosure Form and also provide a copy of the Letter of Representation authorizing the Department of Employee Insurance to correspond with the legal counsel. If the correct information is not provided to the Department of Employee Insurance, there will be no disclosure of information to anyone except the member. The Department of Employee Insurance will only provide information pertaining to eligibility, enrollment, disenrollment and Qualifying Events.

Legal Notices

  
  
HIPAA Privacy Notice.pdfHIPAA Privacy Notice
USERRA Notice on Health Insurance Rights.pdfUSERRA Notice on Health Insurance Rights
COBRA Notice.pdfCOBRA Notice
Children's Health Insurance Program.pdfChildren's Health Insurance Program
2016 KEHP Legal Notices.pdf2016 KEHP Legal Notices
2016 Kentucky Marketplace Notice Part A Only.pdf2016 Kentucky Marketplace Notice Part A Only
2016 Medicare Prescription Drug Creditable Coverage Notice.pdf2016 Medicare Prescription Drug Creditable Coverage Notice
2016 WHCRA Notice.pdf2016 WHCRA Notice
2017 Kentucky Marketplace Notice Part A Only.pdf2017 Kentucky Marketplace Notice Part A Only
2017 Kentucky Marketplace Notice Parts A and B.pdf2017 Kentucky Marketplace Notice Parts A and B
2017 Legal Notices.pdf2017 Legal Notices
2017 Terms and Conditions.pdf2017 Terms and Conditions
2017 Tobacco Use Declaration.pdf2017 Tobacco Use Declaration
2017 WHCRA Notice.pdf2017 WHCRA Notice
2017 Wellness Program Notice.pdf2017 Wellness Program Notice

 

​Legal Forms

  
  
Authorization for Release of Information.pdfAuthorization for Release of Information
Request for Alternate Communications.pdfRequest for Alternate Communications
Request for Restrictions on Use or Disclosure of Protected Health Information.pdfRequest for Restrictions on Use or Disclosure of Protected Health Information
Request to Amend or Correct Protected Health Information.pdfRequest to Amend or Correct Protected Health Information
Request to Inspect or Copy Protected Health Information.pdfRequest to Inspect or Copy Protected Health Information
Request for Accounting of Disclosures of Protected Health Information.pdfRequest for Accounting of Disclosures of Protected Health Information