This notice applies to BeneCare Dental Plans and its members. BeneCare Dental Plans includes dental plans administered by Dental Benefit Management, Inc. and underwritten by Atlantic Southern Dental Foundation and Connecticut Dental Practice Organization, Inc. Throughout this notice, BeneCare Dental Plans is referred to as “we” or “us,” and our plan members are referred to as “you.”

As part of offering and administering your dental plan, we sometimes receive relevant information related to your health condition, the health care services you receive, and payment information related to those services. We will refer to these types of information as “protected health information” or “PHI” throughout this notice. This notice applies to all electronic or paper records we create, obtain and/or maintain that contain your PHI.

Our Responsibilities

We are required by state and federal law to protect the privacy of your PHI. We are also required to give you this notice of the ways we protect and use your PHI, and we are required to notify you in the event your PHI is breached.

How We Use and Disclose PHI

Under the law, there are certain circumstances under which we may use your PHI or disclose it to others without first seeking your authorization. While we take significant precautions to protect your PHI in these circumstances, we nevertheless may share your PHI without your authorization for the reasons described below.

Facilitating your treatment. We can use your dental information and share it with dental professionals who need the information as part of treating you. Example: We can share information back and forth with your dentist related to your dental conditions, the amount of your annual benefit still available, and other facts the dentist needs to create a treatment plan for you.

Payment purposes related to your coverage and your dental services. We can use and disclose your health information as
we attempt to collect any amounts you owe us, and as we pay your dentist(s) for your covered dental services. Example: We share information about you with your dentist to determine coverage and coordinate payment for your dental work, or to bill your plan sponsor, or otherwise in the payment-related administration of your plan.

Health care operations. We can use and disclose your health information as we engage in operations designed operate our plan, including to assess and improve our clinical standards or to follow policies in place to ensure meeting those standards. Example: We can use or disclose information about you and the services you have received as part of performing an analysis of the quality of care provided by our participating dentists.

We are allowed or required to share your information in other limited ways without your authorization. Generally, these are rare circumstances where disclosure is required either for additional administration of the plan or for public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes, and we continue to take all appropriate precautions with your PHI in these circumstances. Some of these circumstances include:

Disclosures to others involved in your care when you are unable to give authorization. If you have a medical emergency, are incapacitated, or are otherwise unavailable to give your consent, we are allowed to use our best judgment to determine whether to disclose your PHI to a person relevant to your care (for example, a close family member).

Disclosures to your plan sponsor as part of administering the plan. We may disclose certain PHI to your plan’s sponsor (who may be your employer) if that information is required for them to administer the plan. That information may only be used in plan administration.

Public health issues. We are allowed (and in some cases, required) to use and disclose your PHI to government entities or other public service organizations if that information is needed in preventing disease, helping with product recalls, or tracking adverse reactions to medications.

Safety issues. We are allowed (and in some cases, required) to use and disclose your PHI to government entities or other public service organizations if that information is needed in reporting suspected abuse, neglect, or domestic violence, or to prevent or reducing a serious threat to anyone’s health or safety.

Other reasons related to legal compliance, law enforcement requests, or government functions. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law. We can also use or share dental information about you for workers’ compensation claims, for certain law enforcement purposes, for health oversight agency activities authorized by law, for special government functions like national security and presidential protective services, and in response to a court or administrative order or subpoena.

Other than for the purposes described above, all uses and disclosures of your PHI require us to obtain your written authorization. This includes, for example, disclosures to a current or prospective employer for any purpose other than plan administration, and using your genetic information for underwriting purposes. Additional protections apply to your PHI when it involves psychotherapy notes, alcohol and drug abuse prevention, treatment, and referrals, HIV/AIDS and other communicable diseases, and genetic testing. We never share your PHI for marketing purposes or sell your PHI.
At any time, you may revoke any written authorization you previously gave us for using or disclosing your PHI. The cancellation must be submitted in writing. The cancellation will not impact disclosures that were made prior to revocation while your authorization was still in effect.

Your Individual Rights

You have rights regarding any PHI of yours that we create, obtain, or maintain. Those rights include:

Requesting restrictions on disclosures. You have a right to ask us to limit the way that we use your PHI for treatment, payment, and health care operations even though those uses technically do not require your authorization. We are not required to honor your request. However, we will consider your request carefully. If we grant your request, we will abide by the
restrictions to which we agree.

Receiving confidential communications. You have a right to ask us to receive communications from us that contain your PHI using alternate means or at alternate locations. We will accommodate reasonable requests for such alternate arrangements. We will accommodate requests when you inform us that you believe failing to do so would put you in danger.

Getting a copy of your claim records and other PHI on file. You have a right to see or get a copy of your dental claim records or other health information we have about you. We will provide a copy or a summary of your dental and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Requesting an amendment or correction of your dental claim records and other PHI. You have a right to ask us to correct the PHI we have in your records if you believe that it is incorrect. If we determine the information is incorrect, we will correct it if permitted to do so by law. If the information in your record that you believe to be incorrect was generated by your dentist or another health care professional, you may need to ask them to correct their information before we are able to do so in our records. If we refuse your request to amend or correct your records, we will tell you why in writing within sixty (60) days.

Receiving an accounting of disclosures of your PHI. You have a right to receive, upon request, a list of the disclosures of your PHI that we have made within a period you specify. This list may exclude disclosures you authorized, disclosures more than six years old, disclosures made for treatment, payment or health care operations purposes, and other disclosures that are excepted by law. You may receive this accounting free of charge once per twelve month period. You may be charged a reasonable fee for additional accountings of disclosures.

Choosing someone to act on your behalf. You have a right to name another person to act as your personal representative. That person may exercise all the same rights that you have related to your PHI. In order for us to recognize your personal representative, we may require that you (or the representative) provide written evidence that you have granted them the authority to act as a personal representative.

Receiving a copy of our notice of privacy practices. You have a right to receive a copy of this notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Filing a complaint. You have a right to file a complaint if you believe your privacy rights have been violated. More information is
on how to file a complaint is available in the “If You Have Questions or Complaints” section below.

If You Have Questions or Complaints

You may contact us. If you have any questions about this document or your privacy rights, or disagree with a decision we have made related to access to your PHI, you may contact us by phone at (800) 843-4727 or in writing at BeneCare Dental Plans, 555 City Avenue, Suite 600, Bala Cynwyd, PA 19004, Attn: Privacy Office.

You may file a complaint with the government. If you believe we may have violated your privacy, rights, you may file a written complaint with the Secretary of the U.S. Department of Health and Human Services (“HHS”). Your complaint can be sent via email, fax, or mail, to the HHS Office of Civil Rights. More information is available at or you may contact us to receive contact information for the HHS Office of Civil Rights.

Non-retaliation. We will never retaliate or take any action adverse to you based on your filing a privacy complaint with us or HHS.

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.

Effective Date of this Notice

September 1, 2018, updated as of April 26, 2019.