Vision Plan of America is devoted to protecting your privacy and the confidentiality of your vision, medical, and personal health information that we may obtain or to which we have access. We do not sell our client information. Your personal information will not be disclosed to nonaffiliated third parties, unless permitted or required by law, or authorized by you in writing.

Throughout this Notice, unless otherwise stated your medical and vision health information refers to only health information created or received by Vision Plan of America and identified in this Notice as Protected Health Information (PHI). Please note that your optometrist maintains your vision records, including payments and charges. Vision Plan of America will have a record of this portion of your PHI only in special or exceptional circumstances, as needed to conduct oversight as mandated by the Knox-Keene Act.

When may Vision Plan of America disclose my PHI without any authorization?
Vision Plan of America is permitted by law to use and disclose your PHI, without your authorization, for purposes of payment and health care administration.

  • Payment purposes include activities to collect premiums and to determine or maintain coverage. These include using PHI in billing and collecting premiums, and related data processing including how your optometrist obtains pre-authorization for certain vision services.
    For example, Vision Plan of America periodically conducts quality assurance inspections of your optometrist’s office and during such visits may review your vision records as part of this audit.
  • Healthcare Administration means basic activities essential to Vision Plan of America’s function as a licensed Health Care Service Plan, and includes reviewing the qualifications and competence of your optometrist: evaluating the quality of his/her services; providing subscriber services and information including answering enrollee inquiries but without disclosing PHI. Vision Plan of America may, for example, review your optometrist’s records to determine if the co-payments being charged by the office comply with the contract under which you receive vision coverage.
  • In addition, Vision Plan of America is permitted to use and disclose your PHI, without your authorization, in a variety of other situations, each subject to limitations imposed by law. These situations include, but are not limited to, the following uses and disclosures:
    • Public health activities;
    • Concerning victims or abuse, neglect or domestic violence;
    • Health oversight agency;
    • Judicial and administrative proceedings including the defense by Vision Plan of America of a legal action proceeding brought by you;
    • Law enforcement purposes, subject to subpoena or law;
    • Workers Compensation purposes;
    • Parents or guardian of a minor; and
    • Persons or entities who perform services on behalf of Vision Plan of America and from whom Vision Plan of America has received contractual assurances to protect the privacy of your PHI.

Is Vision Plan of America ever required to get my permission before sharing my PHI?
Uses and disclosures of PHI other than those required or permitted by law will be made by Vision Plan of America only with your written authorization. You may revoke any authorization given to Vision Plan of America at any time by written notice of revocation to Vision Plan of America except to the extent that Vision Plan of America has relied on the authorization before receiving your written revocation. Uses and disclosures beyond those required or permitted by law, or authorized by you are prohibited.

Does my employer have the right to access my PHI?
If you are an enrollee under a plan sponsored by your employer, Vision Plan of America will not disclose PHI to your employer except under the following conditions:

  • You sign an authorization for the release of your vision/dental information, or
  • Health care services were provided with specific prior written request and expense of the employer, and are relevant in a grievance, arbitration or lawsuit, or describe limitations entitling you to leave work or limit work performance.

Who should I contact if I have any questions regarding my privacy rights with Vision Plan of America?
You may obtain further information regarding your PHI privacy rights by contacting your Vision Plan of America’s Member Services Specialists at 1-800-400-4872 during regular office hours.