1. Purpose for Policy
Northern Insuring Agency, Inc. places a high value on the privacy of its clients (“Clients”) and the expectation that information regarding Clients remains confidential and is made available only to persons who have a legitimate right to know. In addition, Northern Insuring Agency, Inc. is contractually obligated to comply with the privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Northern Insuring Agency, Inc. recognizes that all employees and temporary workers (“Employees”), as well as outside contractors, have an ethical and legal obligation to keep certain information about Clients confidential and to protect and safeguard this information against unauthorized use or disclosure.
3. Procedures - The following section outlines the basic procedures necessary to comply with this policy.
Disclosure of Information
• An Employee may access, discuss, use and disclose PHI only for Northern Insuring Agency, Inc. business as it relates to that employee’s specific job functions and/or responsibilities.
• Employees may disclose PHI only to those who have a legitimate, Northern Insuring Agency, lnc.-related business need to know or who have prior written authorization. PHI about a Client may only be shared for purposes of claims payment or healthcare operations
• PHI must never be the subject of casual conversation either inside or outside of the workplace. PHI must not be discussed in lobbies, stairwells, elevators, restrooms, hallways, or any other public area where conversation could be easily overheard by visitors and Employees who do not have a need to know.
• Only “Minimally Necessary” PHI may be disclosed. “Minimally Necessary” means only that amount of PHI necessary to accomplish the intended purpose of the use or disclosure.
Access to Information
• PHI may only be accessed if related to specific job functions and responsibilities.
• Casual reading of PHI is not permitted.
• Employees with legitimate access to PHI will protect this information from casual or unauthorized access.
Security of PHI
• Employees may remove PHI from the facility only as it relates to specific job functions and/or responsibilities. Approval from an employee’s direct manager is necessary to remove PHI from the facility. It is the responsibility of each Employee to protect and safeguard all such information.
• Employees are encouraged to review PHI in a secure area and are responsible for records that are checked out to them. It is the responsibility of the Employee to protect and safeguard all records that are removed from the secure areas.
• Technical security safeguards are used to store, process and transmit electronic PHI. Our IT staff has primary responsibility for the security oversight of electronic PHI. Employees are responsible for complying with these security safeguards. All workstations that store, process or otherwise access electronic PHI must be protected with a strong password. Open sessions will be disconnected after a period of inactivity.
Breach of Confidentiality
• Any Employee who believes he/she has observed a breach of security or confidentiality should promptly notify his or her direct manager or the Chief Information Security Officer (CISO).
• Employees found to be in violation of this policy may be subject to disciplinary action, up to, and including termination and/or legal action. PHI is protected by federal and state laws and regulations that define civil and criminal penalties for violations of confidentiality.
• Northern Insuring Agency, Inc. will periodically conduct unscheduled audits to ensure compliance with this policy.
In order to maintain confidentiality, any item containing PHI must be discarded according to the standards identified below
Examples: Medical records, applications, census files, or any other paper-based document containing PHI
Where/How to Discard: Paper-based PHI should be placed in a sealed recycle bin for destruction or destroyed by shredding. Electronic copies stored in the Northern Insuring Agency, Inc. Document Management System will be password protected using encryption procedures.
Examples: Computer hard drives, disks, e-mails and electronic files Where/How to Discard: The IT staff will remove the hard drive from each computer or laptop that is scheduled for disposal. These hard drives will be physically secured until they are destroyed or recycled. Computers that will be reused must cleared or purged to remove PHI. Disks should be destroyed or re-formatted. E-mails and electronic files should be purged from the system after use. Employees needing assistance in disposing of electronic files should contact a member of our IT staff.
Employees must not leave any PHI on fax machines, printers or copiers.
Employees are to clean their workspace of PHI at the end of their work day and place the PHI in a secure location.
Employees must exercise caution and discretion when leaving voicemail messages containing PHI.
Employees are to escort visitors through work areas.
Employees must exercise caution and discretion when e-mailing PHI internally within Northern Insuring Agency, Inc ..
Employees must use appropriate encryption software when e-mailing PHI outside of Northern Insuring Agency, Inc ..
Employees must not store PHI on handheld devices, such as PDAs or smartphones.
Employees must secure all hardcopy mail containing PHI.
Employee workstations will be programmed to auto-lock after 15 minutes of inactivity.
Employees should refrain from loading PHI on pooled laptops. Information stored on laptops will be routinely purged.