1. The Independence Personal Health Record Web Portal
Your personal health record (“PHR”) is your voluntary online resource to store, maintain, track, and organize your health information in a centralized private and secure location. The information in your PHR is secured and confidential. Independence does not review the contents of your PHR, except as may be necessary to provide the service (for example, we may incidentally review your data while fixing a technical issue) or as required by law. If you choose to create a PHR, Independence will populate it with certain personally identifiable information automatically.
The Independence Claims Data is provided to you for informational purposes only. The PHR is not a complete medical record and does not include all services, tests, products or medical advice that you may have received, or constitute the official medical record of such services, tests, products or medical advice. Nothing contained in the PHR is intended to be medical advice or instructional for medical diagnosis or to suggest or recommend a course of treatment. And, the PHR furnished on the WebMD site is not intended to replace personal consultation with a qualified health care professional.
The contents of the PHR include all Claims Data from 2006 to the present except for Claims Data relating to what we refer to as “sensitive health conditions.” “Sensitive health condition” Claims Data is claims information concerning conditions such as mental or behavioral health, HIV/AIDS, sexually transmitted diseases, substance abuse, or genetic testing.
Once you accept the Independence Website Terms and Conditions, Claims Data submitted to Independence will be automatically loaded into your PHR. You may opt out of the PHR program entirely, in which case you will have no further access to the WebMD website.
Please note that once your Claims Data is loaded automatically in your PHR, there will be a time period before the information appears while the data is collected, verified and transmitted to the PHR. Claims Data is updated weekly and is usually available in approximately 7–14 days after the information has been processed by Independence. If you have any questions or concerns regarding updating your PHR, please contact Independence customer service at 800-ASK-BLUE (800-275-2583).
Once Claims Data or other specific information is added to the PHR, you have the option to show or hide that specific information in your PHR. Although the on-line version of the PHR you can review will remain unchanged, you have the option to show or hide specific information when you print out your PHR to share with your family and/or health care provider.
The most useful PHR is the one that is the most complete and user-friendly, so that it can help you keep track of your health and get services that are necessary.
Please note that your PHR cannot be used to communicate with Independence. In the event that you wish to correct a medical record or other statement in the PHR, you must contact Independence customer service at 800-ASK-BLUE (800-275-2583). Although you may enter comments, notes, and other information in your PHR, remember that your PHR will not be reviewed or changed by Independence.
In the event that you are no longer an Independence Member, you may access your Independence PHR for up to three (3) months after leaving Independence. Independence will not have access to claims information provided by hospitals, physicians, labs and other providers when you were not an Independence Member.
2. The Clinical Care Report
Your Clinical Care Report (“CCR”) is a compilation of certain of your paid claims data (“Claims Data”) from the last four years that have been consolidated in a centralized secure location and made available to your PCP and certain other “qualified providers” (as these as these providers are described later in this section) solely for the purposes of identifying opportunities for improving clinical quality and outcomes for you. A CCR is created for every Independence Member, but you may opt out of having the CCR made available to your PCP or to other qualified providers by logging into the Member Portal or by calling Customer Service (as explained in more detail below). In the event that you are no longer an Independence Member, Independence will no longer compile Claims Data and your PCP will no longer be authorized to access your Independence CCR. The contents of the CCR include all Claims Data from 2006 to the present except for Claims Data relating to what we refer to as “sensitive health conditions”. “Sensitive health condition” Claims Data is claims information concerning conditions such as mental or behavioral health, HIV/AIDS, sexually transmitted diseases, substance abuse, or genetic testing. Independence will add Claims Data to your CCR periodically. You are not able to add information, such as notes, comments, and prior medical history, into your CCR at any time. Claims Data submitted to Independence will be made available to your PCP and other qualified providers. You may opt out of the CCR entirely, in which case your PCP and other providers will have no further access to your CCR. Please note that once your Claims Data is loaded automatically in your CCR, there will be a time period before the information appears while the data is collected, verified and transmitted to the CCR. Claims Data is updated weekly and is usually available in approximately 7-14 days after the information has been processed by Independence. If you have any questions or concerns regarding updating your CCR, please contact Independence customer service at 800-ASK-BLUE (800-275-2583).
You may opt out of the CCR functionality by logging in to the Member Portal and changing your settings by clicking on the Customer Service tab, finding the section entitled “My Self-Service Tools” and then clicking on the link to “Manage Clinical Care Report”. You then should select “Do not share my Clinical Care Report”.You also may opt out of the CCR functionality by contacting Customer Service by phone at 800-ASK-BLUE (800-275-2583). Opting out of the CCR functionality will prevent your PCP (or any other qualified providers) from accessing your CCR. .Unless you opt out, Independence will provide electronic access to your CCR to your PCP and certain other providers who have agreed to abide by certain terms and conditions (“qualified providers”). Qualified providers are those providers that identify a need for access to your CCR because of one of three specified medically necessary reasons: (1) the provider is addressing your current emergency medical need within the next thirty (30) days; (2) you have a scheduled appointment within one (1) year of the provider’s request to view the CCR; or (3) the provider has an existing patient relationship with you, such as having treated you or seen you within the prior year. Any non-PCP provider that does not satisfy these eligibility criteria is not considered a qualified provider and will not be authorized to access your CCR. The Independence Claims Data is provided to your PCP and other qualified providers solely for the purposes of identifying opportunities for improving clinical quality and outcomes for you. The CCR is not a complete medical record and does not include all services, tests, products or medical advice that you may have received, or constitute the official medical record of such services, tests, products or medical advice. Nothing contained in the CCR is intended to be medical advice or instructional for medical diagnosis or to suggest or recommend a course of treatment.
Independence does not include in your CCR claims information provided by hospitals, physicians, labs and other providers when you were not an Independence Member. Accordingly, your CCR may identify gaps in information for which Independence has no record. Such gaps in information will be identified on your CCR simply to indicate that Independence does not have any information regarding claims paid during that specific time period.
3. Collection of Personal Information from Site Visitors to Independence’s Website
When you visit www.ibx4you.com (including the Independence Web portal through which you access your PHR), or when you visit one of our other Websites, Independence may collect and/or track: (1) your home server domain names, your email address, your type of computer, the files downloaded, the search engine used, operating system, and type of web browser; (2) the email addresses of visitors who communicate with Independence via email; (3) information knowingly provided by the visitor in online forms, surveys, email, contest entries, and other online submissions (including demographic and personal profile data), and (4) aggregate information on pages accessed by a visitor.
To better serve you, we use “cookies” to customize your browsing experience. Cookies are simple text files stored by your browser, and they provide a method of distinguishing among visitors to our sites. We use “cookies” to store a randomly generated tag on your computer such that when you revisit our sites, we may recognize the visitor by the Internet cookie and customize the visitor’s experience accordingly. The cookies created on your computer by using our sites do not contain personally identifiable information. You may refuse a cookie, or delete the cookies file from your computer at any time by using any one of a number of widely available methods. However, you should be aware that if you disable the “cookies” feature of your browser, you may not be able to use the portals within our site.
When a visitor performs a search on our Website, we may record information identifying the Visitor or linking the visitor to the search performed. Independence also may record limited information for every search request and use that information only to solve technical problems with the service and to calculate overall usage statistics.
4. Use of Online Personal Data Collected Through Independence’s Website
When you access the Website (including the Independence Web portal by which you access your PHR), you may choose to give Independence online personal information about you. “Online personal information” is any information or data you provide through this Website that is individually identifiable, such as a name, address, postal address, email address, birth date, phone number, and other personal information, including health information that you voluntarily provide to Independence. It also may include other information that we collect about you that is associated with your name or address, such as your email address. You may provide that information to us on our registration page, if you email us, or at some other point during your online interaction.
Independence may use the online personal information for a number of different reasons, including editorial and feedback purposes, health care marketing and promotions, performing a statistical analysis of visitor usage, product development, content improvement, to protect our rights or property, or to customize the content and layout of our site. Aggregate data that does not identify individual users may be used for internal purposes or provided to third parties.
Personally identifiable information that visitors voluntarily provide to Independence, online or offline, may be added to our databases and used for future communications, which may include Website updates, new products and services, the confirmation of transactions through the portals, upcoming events, or health reminders, and for other purposes in accordance with applicable state and federal law.
Online personal information may or may not be individually identifiable health information that is also protected by the federal HIPAA privacy law (“the HIPAA Privacy Rule”). Where online personal information also constitutes individually identifiable health information under the HIPAA Privacy Rule, the provisions of this Privacy Rule also will govern Independence’s permitted uses and disclosures of the online personal information.
5. Disclosure of Online Personal Data Collected Through the Independence Website to Third Parties
Unless otherwise authorized by a visitor, Independence will not sell, rent, license, or disclose personally identifiable information collected through the Independence Website to unaffiliated third parties. Under the HIPAA Privacy Rule, however, Independence is permitted to disclose individually identifiable health information to business associates who perform various functions or provide services on their behalf. To perform these functions or to provide services, business associates will receive, create, maintain, use, or disclose individually identifiable health information that has been provided to or made available to the business associate by Independence, but only after we require the business associates to agree in writing to contract terms designed to safeguard your information.
Independence has contracted with certain third party vendors such as WebMD to serve as its business associate to provide services in connection with Independence’s Web portals.
Except as set forth above, Independence will not release personally identifiable information to any party unless required to do so by government authorities or legal process in accordance with applicable law , in order to protect our rights or property, or in conjunction with an acquisition of all or part of our company. Laws that permit disclosure of your personally identifiable information as part of healthcare operations might include activities such as Wellness Programs.
6. Wellness Programs and Health Support Programs
Wellness and health support programs (such as but not limited to Healthy LifestylesSM, ConnectionsSM Programs for chronic conditions, Healthy LifestylesSM Rewards Program) are intended to help Members to improve their overall health. They are not intended to replace professional medical advice. Information on Member participation in these programs may be used by Independence for aggregate reporting and outreach purposes.
When appropriate, Independence may share protected health information (or “PHI”) with third party vendors with which Independence has a contract to administer benefits or provide health support services as Independence’s business associates. Such vendors are required to sign a contract with Independence to maintain the privacy of protected health information as required by law. Independence also may share information with treating providers to improve the health care of Members. Providers also must follow all legal confidentiality requirements for PHI.
In addition, when appropriate, we may confirm your enrollment in these programs or in certain preventive health activities, but not your individual responses or final results, with your employer or health and welfare fund (“fund”), for the purpose of an incentive program or corporate wellness planning. For example, we may inform your employer or fund that you completed a “Health Risk Assessment or Personal Health Profile” but will not disclose your answers. We may inform your employer or fund that you attended 10 sessions of a weight management program but not disclose whether you lost any weight. Your individual responses also will not be shared with your employer or fund or their broker/consultant.
7. Links from Independence Blue Cross Websites to Other Websites
Independence Websites occasionally include links to other organizations’ websites for your convenience in locating health-related information, services, and products. Please be advised that when you link to these other sites, you are leaving Independence’s Website and that these other sites are maintained by organizations over which Independence may have no control.
Certain products, services or treatments referred to on other sites that have a link on our site, may not be covered under certain plans offered by Independence. Members should refer to their benefits contract for complete details of the terms, limitations, and exclusions of coverage. In addition, certain providers may not be network providers. Please refer to our provider directory or call Independence to make certain the professional listed is a network provider.
8. Security Measures
Independence has implemented numerous security features to prevent the unauthorized release of or access to personal information. For example, all Independence employees are required to certify their understanding that personal information is considered confidential, that it is important to safeguard personal information, and that Independence will take appropriate action against any employee who fails to acknowledge these facts or adhere to the requisite security standards of conduct.
The Independence web portals use 128-bit encryption to help keep information secure. You will not be able to view certain pages of our site unless your computer has 128-bit encryption. You should also be aware that despite these and other security measures implemented by Independence, no security process is completely foolproof. We will continually assess our security procedures and modify them to protect your information and we ask that our visitors take the appropriate measures to protect their information.
If you register for one of our Web Portals, you will have the opportunity to receive or create a password to access view or submit personal information. Visitors who register to use a Web Portal should not divulge their password to anyone, and Independence will never ask for your password in an unsolicited phone call or email. When you are finished with applications that are password-protected, you should exit the page.
You should be aware that the confidentiality of any communication or material transmitted to/from Independence via this site or email cannot be guaranteed. Independence is not responsible for the security of information transmitted via the Internet.
9. Opt-out Right
Visitors may opt out of having certain personally identifiable information, i.e. PHI, used by Independence or its affiliates for health-related marketing or other health-related promotional communications by contacting Independence via regular mail or email at the addresses above. This opt-out right does not apply to Independence’s collection of the type of web browser of visitor to Independence’s site or the sharing of PHI permitted under the HIPAA Privacy Rule for treatment or health care operations as part of wellness and health support programs as described above.
In sections of the Member website that are “WebMD Health Services Group, Inc.” visitors may customize their preferences regarding receipt of email health reminders and other electronic communications. This is done by accessing the “settings” tab.
10. Access to and Ability to Correct Online Personal Data.
11. Collection of Online Personal Data From Children.
Although parents are free to seek information available on this Website concerning the health of their children, no person under 18 years old is permitted to use this Website. Independence does not direct this Website to children under the age of 18 years or knowingly collect personal information from children under 18. Adults should not assist minors in accessing the Site. When visitors enter personal information on our Website, the visitor is representing to us that he/she is an adult over 18 years old.
To the extent that Independence is able to determine the age of visitors by their submissions to or communications with Independence’s site, Independence will not knowingly (1) collect or post information from individuals under age 18 without their parent’s or guardian’s consent, or (2) provide any personally identifying information collected from children, regardless of its source, to any third party for any purpose whatever unless otherwise permitted by law.
More specifically, if registration is required for any services on the Independence Website, and a visitor submits information to Independence’s Website through such a registration process that indicates that such visitor is a child, the child’s parent or guardian will be alerted to the child’s registration and will be provided instructions on how the parent or guardian can delete the child’s registration, if so desired. No information collected through Independence’s Website from visitors who identify themselves as children will knowingly be used for any direct marketing or promotional purposes. If there are no age restrictions on a contest that requires registration, and if a child wins, notification and prizes will be sent to the parents or guardians identified in the initial registration process.
12. Independence Blue Cross’s Right to Contact Visitor.
Terms and Conditions of Access
Independence Blue Cross (“Independence”) provides you with access to its Website and Member Portal (collectively, the “Portal”), subject to the following Terms and Conditions of Access (“Terms and Conditions”).
1. THE CONTENT OF THE PORTAL IS NOT INTENDED IN ANY WAY TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH PROVIDER WITH ANY QUESTIONS YOU MAY HAVE REGARDING A MEDICAL CONDITION. NEITHER THE CONTENT NOR ANY OTHER SERVICE OFFERED BY OR THROUGH THE PORTAL IS INTENDED TO BE RELIED ON FOR MEDICAL DIAGNOSIS OR TREATMENT. NEVER DISREGARD MEDICAL ADVICE OR DELAY IN SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ ON THE PORTAL! IN AN EMERGENCY, CALL 911 OR YOUR LOCAL EMERGENCY ASSISTANCE NUMBER.
2. Independence reserves the right to terminate access to the Portal at any time and for any reason. Your access will be terminated automatically when your benefits are no longer provided by Independence and its subsidiaries or affiliates. Independence reserves the right at any time to modify or discontinue, temporarily or permanently, the Portal (or any part thereof) with or without notice. You agree that Independence will not be liable to you or to any third party for any modification, suspension or discontinuance of the Portal.
3. Independence has created certain security procedures, including the use of passwords and user identification numbers, to assist in keeping your information confidential. You agree to provide us with accurate, current and complete information about yourself as requested and to maintain and promptly update your information to keep it accurate, current and complete.
4. You are responsible for maintaining the confidentiality of the password and are responsible for all activities that occur under your password. You agree to immediately notify Independence of any unauthorized use of your password or other breach of security, and to exit from your account at the end of each session. Independence cannot and will not be liable for any losses and/or damages arising from your failure to comply with these provisions. Except where expressly authorized by law, you certify that you are not using another person’s password or user identification to access the Portal. You agree not to falsely state or otherwise misrepresent your affiliation with a person or entity to obtain access to a Portal. You also agree not to copy or disseminate, electronically or otherwise, personal or confidential information found on the Portal.
5. You agree that Independence, in its sole discretion, may terminate your password, user identification (or any part thereof) or use of the Portal for any reason, including, for lack of use or if Independence believes that you have violated the Terms and Conditions. You agree that Independence will not be liable to you or any third party for any termination of your access to the Portal.
6. The information provided on the Portal is provided as an accommodation and it is not intended to serve as formal notice or publication as may be required under law or by contract. While Independence uses its best efforts to maintain the accuracy and reliability of information available through the Portal, we cannot guarantee the accuracy of the claims information or that all claims will be found by using the “search” feature of the Portal. You understand and agree that Independence, except as expressly required by law, assumes no responsibility for the timeliness, deletion, mis–delivery or failure to provide any information on the Portal.
7. Independence has agreements with various entities, which we call our “business associates,” to provide services in connection with the Portal. Our relationships with business associates are based on the type of service they are to provide.
8. YOUR USE OF THE PORTAL IS AT YOUR SOLE RISK. THE PORTAL IS PROVIDED ON AN “AS IS” AND “AS AVAILABLE” BASIS. Independence EXPRESSLY DISCLAIMS ALL WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON–INFRINGEMENT. YOU EXPRESSLY UNDERSTAND AND AGREE THAT Independence WILL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR EXEMPLARY DAMAGES FOR ANY REASON RESULTING FROM THE USE OF THE PORTAL.
9. You agree to release and hold Independence and its subsidiaries and affiliates, and their directors, officers, agents, principals or other partners, and employees, harmless from any claims, demands, damages, losses, liabilities, costs and expenses, including reasonable attorneys’ fees, made by any third party due to or arising out of your use of the Portal, your violation of these Terms and Conditions, your communication of inaccurate or incomplete information, and/or your violation of law.
13. The Portal may include or provide links to other websites on the Internet including, but not limited to, links to our business associates’ web pages. These other websites may provide opinions, recommendations, or other information from various individuals, organizations or companies. IN PROVIDING LINKS TO THE WEBSITES OF THIRD PARTIES, Independence DOES NOT INVESTIGATE THE CONTENT OF SUCH INFORMATION AND DOES NOT ENDORSE, GUARANTEE OR WARRANT THE ACCURACY OF SUCH INFORMATION OR NECESSARILY SUBSCRIBE TO ANY SUCH OPINIONS OR RECOMMENDATIONS. TO THE EXTENT THAT YOU MAKE USE OF ANY LINK TO ANY OTHER WEBSITE ON THE INTERNET, YOU UNDERSTAND AND AGREE YOUR USE OF THE WEBSITES OF THIRD PARTIES IS AT YOUR SOLE RISK. THE WEBSITES OF THIRD PARTIES ARE PROVIDED ON AN “AS IS” AND “AS AVAILABLE” BASIS. Independence EXPRESSLY DISCLAIMS ALL WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NON–INFRINGEMENT. YOU EXPRESSLY UNDERSTAND AND AGREE THAT Independence WILL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR EXEMPLARY DAMAGES FOR ANY REASON RESULTING FROM YOUR USE OF THE WEBSITES OF THIRD PARTIES.
14. You understand that Pennsylvania law requires that any person knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any false information or conceals for the purposes of misleading, information concerning any material fact thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.