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PPSLRSWMO Privacy Notice Statement

Certified Application Counselor Designated Organization (CDO)

In order to provide the Certified Application Counselor Assistance you are voluntarily seeking, Planned Parenthood of the St. Louis Region and Southwest Missouri and our Certified Application Counselors may gain access to your personally identifiable information (PII).  This Privacy Notice Statement describes how Planned Parenthood of the St. Louis Region and Southwest Missouri will maintain any PII that Planned Parenthood of the St. Louis Region and Southwest Missouri and/or its Certified Application Counselors may access during the Assistance provided to you.

 

What is PII?

PII is any information that can be used to learn your identity.  Some examples are:

  • Names
  • Social Security Number
  • Date and Place of Birth
  • Mothers Maiden Name
  • Medical, educational, financial and/or employment information
  • Phone number
  • Home Address
  • Driver’s License Number

 

Planned Parenthood of the St. Louis Region and Southwest Missouri and CAC Authority to access PII

Planned Parenthood of the St. Louis Region and Southwest Missouri and CACs are authorized to access your PII pursuant to the Affordable Care Act and implementing rules and regulations.  You or your authorized representative will be requested to sign a written authorization form, permitting access to your PII, before a CAC can assist you.  This is entirely voluntary; however, if you do not grant permission to access your PII the CAC will not be able to provide assistance.  You have the right to revoke this authorization and discontinue assistance at any time.

PII will be requested only for the following purposes:

  • To provide information about the full range of qualified health plan options and insurance affordability programs for which you are eligible.
  • To assist you with applications
  • To assist you with enrollment
  • To assist you with an application for an exemption from the individual responsibility requirement
  • To perform other functions which are authorized by 45 CFR 155.225 and/or CMS

 

Storage of PII

CACs may discuss or access your PII when assisting you and/or your authorized representative.  CACs will not maintain or store any of your PII (or the PII of your authorized representative) in written form except on the authorization form you or your authorized representative are required to sign for a CAC to assist you.  This form will require your name and signature and, if you choose to provide it, your phone and/or email address.  This form will be stored by Planned Parenthood of the St. Louis Region and Southwest Missouri in a locked file in a secure location and will be destroyed under time frames determined by CMS and legal authority.

 

Entry of PII into Marketplace Website or Forms

The Marketplace has privacy and security standards and procedures in place to protect your PII.

 

Disclosure

Your PII will not be disclosed to anyone except to authorized Planned Parenthood of the St. Louis Region and Southwest Missouri volunteers and staff who have undergone security and privacy training and only on an as-needed basis to carry out the functions of a CAC and CAC Designated Organization.

 

Your Right to Access and Change your PII

You or your Authorized representative has the right to access and change (update, delete, substitute, correct) any of your PII that Planned Parenthood of the St. Louis Region and Southwest Missouri has maintained and stored.  You must submit your request in writing to “CAC Record Request” or “CAC Record Change” and specify which PII you are requesting access to, or which PII you wish to change, including the reasons for the change.  You must also verify your identity by providing a copy of a driver’s license, and ID card issued by the government, or other forms of ID approved by Planned Parenthood of the St. Louis Region and Southwest Missouri.  Planned Parenthood of the St. Louis Region and Southwest Missouri will provide your PII to you or make the requested change within ten (10) days following your request, unless after review Planned Parenthood of the St. Louis Region and Southwest Missouri denies your request.  If your request is denied, you will be provided written notice regarding the reason and you will be provided information regarding how you may appeal the denial.  Appeals will be considered by a designated CAC Privacy Official.  Appeals will be reviewed and decided within ten (10) days following the receipt of appeal.  Requests to change PII, or appeal PII decisions should be sent to:

 

CAC Privacy Official

Planned Parenthood of the St. Louis Region and Southwest Missouri

4251 Forest Park Ave

St. Louis, MO 63108

 

Changes to this Notice

We reserve the right to change this Notice.  We reserve the right to make the revised or changed notice effective with respect to your PII we already have as well as information we may obtain from you if you seek the assistance of the CAC program in the future.  We will post a copy of our current Notice on our website with the effective date.

 

Complaints

If you believe your privacy rights have been violated, you may file a complaint with Planned Parenthood of the St. Louis Region and Southwest Missouri by contacting:

 

CAC Privacy Official

Planned Parenthood of the St. Louis Region and Southwest Missouri

4251 Forest Park Ave

St. Louis, MO 63108

 

You may also file a complaint with the Marketplace directly by calling the Marketplace Call Center at 1-800-318-2596.

 

This statement provides the notice required by 45 CFR 155.225 and 45 CFR 155.260

Updated: 06/02/2015