1. Uses and Disclosures of Protected Health Information for Treatment, Payment & Health Care Operations. We may use or disclose your Protected Health Information for purposes of treatment, payment and health care operations. Permitted uses and disclosures for these purposes are described more fully below.
• Treatment. We may disclose your Protected Health Information to assist with your treatment. For example, we may give your dentist information about your prior dental care so that he can determine the best course for future treatment.
• Payment. We may use or disclose your Protected Health Information to fulfill our responsibilities to provide coverage under your dental benefits plan, to obtain premium payments for that coverage, and to pay or obtain other appropriate reimbursements for that coverage. Examples of these activities include, determining your eligibility or coverage, coordinating our coverage with coverage provided to you by other health plans, or reviewing dental care services provided to you to determine whether they are covered by your policy.
• Health Care Operations. We may also use or disclose your health care information for a variety of purposes related to the management or administration of our dental benefit program. These activities include the following:
• Disclosures for quality assessment and improvement activities; for example, we may use or disclose your health information in measuring and improving the timeliness and appropriateness of dental care received by you and other enrollees in our dental benefit program;
• Population-based activities relating to improving health or reducing health care costs, and protocol development; for example, we may use your health information, along with that of others, to evaluate the effectiveness of various dental treatments and procedures;
• Case management, care coordination and related functions; for example, we may use your health information in contacting you or your dentist to provide information about treatment alternatives;
• Reviewing performance of our health plan and its participating dentists; for example, we may use or disclose your health information for the purposes of determining whether our plan provides you with adequate access to and reimbursement for dental care in your area;
• Conducting training programs for our staff, dentists and other professionals; for example, we may use or disclose your health information for the purpose of teaching our staff how to properly evaluate dental claims;
• Underwriting, premium rating, and other activities relating to the creation, renewal or replacement of a contract of dental insurance, for example, we may use or disclose your health information to determine what premiums we should charge for our dental benefit plan;
• Arranging for reinsurance of risk relating to claims for health care; for example, we may use or disclose your health information for the purpose of ensuring our ability to fully pay all claims in a timely fashion;
• Conducting or arranging for dental review, legal services, accounting functions, and detection of fraud and abuse; for example, we may use or disclose your health information for the purpose of obtaining the opinion of another dentist about the appropriateness of the dental care provided to you under our dental plan;
• Business planning and development; for example, we may use or disclose your health information for the purposes of evaluating necessary expansions of our provider panel;
• Management activities relating to compliance with state and federal privacy laws; for example, we may use or disclose your health information for the purposes of determining what protections must be afforded your health information;
• Providing customer service; for example, we may use or disclose your health information for the purposes of assisting you or your employer in resolving questions concerning your coverage or benefits under our dental benefit plan;
• Resolution of grievances; for example, we may use or disclose your health information in evaluating your complaints or those of your dentist regarding our policies and procedures;
• The sale, transfer, merger or consolidation of all or part of our company with another entity that is covered or will be covered by the federal government’s privacy rules for individual health information; for example, we may use or disclose your health information for the purpose of accomplishing a merger between our company and other health plan; and
• Creating de-identified health information or a limited data set; for example, we may use or disclose your health information for the purpose of providing your employer a summary of the dental benefits provided by our dental benefit program.
• Plan Sponsors & Business Associates. We may disclose certain Protected Health Information to your employer or other sponsor of your group dental plan for purposes related to administration of the plan; for example, we may provide your employer information regarding your enrollment in the plan, for modifying the plan, or for administering the plan. Delta Dental may also disclose Protected Health Information about you without your authorization to business associates of the Plan, such as actuaries who price the cost of coverage or other entities that perform services on our behalf.
2. Other Uses and Disclosures of Protected Health Information for Which Your Written Authorization Is Not Required
• Generally. We may use or disclose your Protected Health Information for a number of circumstances in which you do not have to consent, give authorization or otherwise have an opportunity to agree or object. Those circumstances include:
• When the use or disclosure is required by law; for example, when a disclosure is required by federal, state or local law or other judicial or administrative proceeding;
• When the use or disclosure is necessary for public health activities; for example, we may disclose Protected Health Information about you if you have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition;
• When the use or disclosure relates to victims of abuse, neglect or domestic violence;
• When the use or disclosure is for health oversight activities; for example, we may disclose Protected Health Information about you to a state or federal health oversight agency that is authorized by law to oversee our operations;
• When the use or disclosure is for judicial and administrative proceedings; for example, we may disclose Protected Health Information about you in response to an order of a court or administrative tribunal;
• When the use or disclosure is for law enforcement purposes; for example, we may disclose Protected Health Information about you in order to comply with laws that require the reporting of certain types of wounds or other physical injuries;
• When the use or disclosure relates to decedents; for example, we may disclose Protected Health Information about you to a coroner or medical examiner for the purposes of identifying you should you die;
• When the use or disclosure relates to cadaveric organ, eye or tissue donation purposes;
• When the use or disclosure relates to medical research; for example we may disclose Protected Health Information about you for the purpose of determining the frequency of certain dental conditions;
• When the use or disclosure is necessary to avert a serious threat to health or safety; for example, we may disclose Protected Health Information about you to prevent or lessen a serious and eminent threat to the health or safety of a person or the public;
• When the use or disclosure relates to specialized government functions; for example, we may disclose Protected Health Information about you if it relates to military and veterans’ activities, national security and intelligence activities, protective services for the President, and medical suitability or determinations of the Department of State;
• When the use or disclosure relates to correctional institutions and in other law enforcement custodial situations; for example, in certain circumstances, we may disclose Protected Health Information about you to a correctional institution having lawful custody of you; and
• When the use or disclosure is necessary to comply with workers’ compensation or other similar programs.
• Uses and Disclosures to Which You May Object. Unless you object, we may use or disclose Protected Health Information about you in the circumstances described below. If you would like to object to our use or disclosure of Protected Health Information in these circumstances, please contact the Delta Dental Privacy Official using the contact information given below.
• We may share with a family member, relative, friend or other person designated by you, Protected Health Information directly related to that person’s involvement in your care or payment for your care. We may share with a family member or other person responsible for your care Protected Health Information necessary to notify such individuals of your location, general condition or death.
• We may share with a public or private agency (for example, the American Red Cross) Protected Health Information about you for disaster relief purposes. Even if you object, we may still share the Protected Health Information about you in emergency circumstances.
3. Notwithstanding anything to the contrary in this notice, the use or disclosure of Protected Health Information may be prohibited or materially limited by other applicable laws, such as state laws that are more stringent than federal privacy rules.

Your Rights Concerning Your Protected Health Information 
Right to Request Restrictions on Certain Uses and Disclosures of Protected Health Information. You have the right to request that we restrict the use and disclosure of Protected Health Information about you. We are not required to agree to your requested restrictions. You may request a restriction by contacting the Delta Dental Privacy Official using the contact information provided below.

Right to Receive Confidential Communication. You have the right to request how and where we contact you about Protected Health Information. For example, you may request that we contact you at your work address or phone number or by email. Your request must be in writing. We must accommodate reasonable requests if you state that the disclosure of all or part of the information could endanger you. However, we may condition our accommodation on your providing us with information regarding how payment, if any, will be handled and your specification of an alternative address or other method of contact. You may request alternative communications by contacting the Delta Dental Privacy Official using the contact information provided below.

Right to Inspect and Copy Protected Health Information. You have the right to request to see and receive a copy of Protected Health Information contained in our databases that we may use to make decisions about you. Your request must be in writing. We may charge you related fees. Instead of providing you with a full copy of the Protected Health Information, we may give you a summary or explanation of the Protected Health Information about you, if you agree in advance to the form and cost of the summary or explanation. There are certain situations in which we are not required to comply with your request. Under these circumstances, we will respond to you in writing, stating why we will not grant your request and describing any rights you may have to request a review of our denial. You may request to see and receive a copy of Protected Health Information by contacting the Delta Dental Privacy Official using the contact information provided below.

Right to Amend Protected Health Information. You have the right to request that we make amendments to Protected Health Information in the databases we use to make decisions about you. Your request must be in writing and must explain your reason(s) for the amendment. There are certain situations in which we are not required to comply with your request. Under these circumstances, we will tell you in writing the reasons for the denial and describe your rights to give us a written statement disagreeing with the denial. If we accept your request to amend the information, we will make reasonable efforts to inform others of the amendment, including persons you name who have received Protected Health Information about you and who need the amendment. You may request an amendment of your Protected Health Information by contacting the Delta Dental Privacy Official using the contact information provided below.

Right to Receive an Accounting of Disclosures of Protected Health Information. You have the right to receive a written list of certain of our disclosures of your Protected Health Information. You may ask for an accounting of disclosures made up to six (6) years before your request (not including disclosures made prior to April 14, 2003. If you request a list of disclosures more than once in twelve (12) months, we can charge you a reasonable fee. You may request a listing of disclosures by contacting the Delta Dental Privacy Official using the contact information provided below.

Right to Obtain A Paper Copy of this Notice. You have the right to request a paper copy of this Notice at any time by contacting the Delta Dental Privacy Official using the contact information provided below.

Complaints
You have a right to complain to DDNC and to the Secretary of the United States Department of Health and Human Services if you believe that your privacy rights have been violated. You may file a complaint with DDNC by contacting the Delta Dental Privacy Official using the contact information provided below. You will not be retaliated against for filing a complaint.

Contact
For more information concerning this Notice, or to take advantage of the rights described above, contact the Delta Dental Privacy Official at (919) 832-6015. Written communications regarding this Notice or the rights described herein should be directed to: Delta Dental Privacy Official, Delta Dental of North Carolina, 343 E. Six Forks Road, Suite 180, Raleigh, NC, 27609.

Effective Date
This Privacy Notice takes effect on April 14, 2003.