Effective Date: June 18, 2021


This Notice tells you about the ways Community Health Group (referred to as "we" or "the Plan") may collect, use and disclose your protected health information (PHI) and your rights concerning your PHI. "PHI" is information about you, including demographic information, that can reasonably be used to identify you and that relates to your past, present or future physical or mental health or condition, the provision of health care to you or the payment for that care.

We are required by federal and state law to protect your PHI, and to provide you with this Notice about your rights and our legal duties and privacy practices with respect to your PHI. We must follow the terms of this Notice while it is in effect. Some of the uses and disclosures described in this Notice may be limited in certain cases by applicable state laws that are more stringent than the federal standards. These provisions will remain effective even if your coverage is terminated, to the extent we retain information about you.

We also have to notify you if the security and privacy of your information has been breached.


We may use and disclose your PHI for different purposes. The types of data containing HI that we normally maintain are enrollment, claims adjudication, premium payments, case or medical management data, or any other group of records maintained by Community Health Group used in whole or in part to make decisions about a member's eligibility and/or benefits. The examples below are provided to illustrate the types of uses and disclosures we may make without your authorization for payment, health care operations and treatment.

Payment. We use and disclose your PHI in order to pay for your covered health expenses. For example, we may use your PHI to process claims or be reimbursed by another insurer that may be responsible for payment.

Health Care Operations. We use and disclose your PHI in order to perform our plan activities, such as quality assessment and measurement activities or administrative activities, including data management or customer service. We may use member information to:

1) Assess health care disparities

2) Design intervention programs specific to the needs of its member population, using information about language, race/ethnicity, geographic location, and other information to need the needs of its member to improve their health

3) Design and distribute outreach materials

4) Inform health care providers and other network partners about its members’ needs related to such information as language and race/ethnicity.

5) In some cases, CHG may use or disclose PHI information for underwriting purposes or determining premiums.

We will not use member information to perform rate setting or benefit determinations, nor disclose information to unauthorized users. We may not use or disclose PHI that is genetic information for underwriting purposes.

Treatment. We may use and disclose your PHI (including your language and race/ethnicity) to assist your health care providers (doctors, pharmacies, hospitals and others) in your diagnosis and treatment. For example, we may disclose your PHI to providers to provide information about alternative treatments.

Plan Sponsor. If you are enrolled through a group health plan, we may provide summaries of claims and expenses for enrollees in a group health plan to the plan sponsor, which is usually the employer.

Enrolled Dependents and Family Members. We may mail explanation of benefits forms and other mailings containing PHI to the address we have on record for the subscriber of the health plan.


As Required by Law. We must disclose PHI about you when required to do so by law.

Public Health Activities. We may disclose PHI to public health agencies for reasons such as preventing or controlling disease, injury or disability.

Victims of Abuse, Neglect or Domestic Violence. We may disclose PHI to government agencies about abuse, neglect or domestic violence.

Health Oversight Activities. We may disclose PHI to government oversight agencies (e.g., state insurance departments) for activities authorized by law.

Judicial and Administrative Proceedings. We may disclose PHI in response to a court or administrative order. We may also disclose PHI about you in certain cases in response to a subpoena, discovery request or other lawful process.

Law Enforcement. We may disclose PHI under limited circumstances to a law enforcement official in response to a warrant or similar process; to identify or locate a suspect; or to provide information about the victim of a crime.

Coroners, Funeral Directors, Organ Donation. We may release PHI to coroners or funeral directors as necessary to allow them to carry out their duties. We may also disclose PHI in connection with organ or tissue donation.

Research. Under certain circumstances, we may disclose PHI about you for research purposes, provided certain measures have been taken to protect your privacy.

To Avert a Serious Threat to Health or Safety. We may disclose PHI about you, with some limitations, when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Special Government Functions. We may disclose information as required by military authorities or to authorized federal officials for national security and intelligence activities.  

Workers' Compensation. We may disclose PHI to the extent necessary to comply with state law for workers' compensation programs.


Other uses or disclosures of your PHI that are not described in this notice will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke an authorization at any time in writing, except to the extent that we have already taken action on the information disclosed or if we are permitted by law to use the information to contest a claim or coverage under the Plan. Disclosures for which your authorization is needed include, but are not limited to, the following:

Marketing. PHI will not be used for marketing without your written authorization, unless the product or service is discussed face to face with you, or given as a promotional gift of nominal value.

Sale of Protected Health Information. Disclosures that would be a sale of PHI require your written authorization.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION You have certain rights regarding PHI that the Plan maintains about you.

****** IMPORTANT ******


Right to Access Your PHI. You have the right to review or obtain copies of your PHI records, with some limited exceptions. Usually the records include enrollment, billing, claims payment and case or medical management records.

Your request to review and/or obtain a copy of your PHI records must be made in writing. We may charge a fee for the costs of producing, copying and mailing your requested information, but we will tell you the cost in advance.

Right to Amend Your PHI. If you feel that PHI maintained by the Plan is incorrect or incomplete, you may request that we amend the information. Your request must be made in writing and must include the reason you are seeking a change. We may deny your request if, for example, you ask us to amend information that was not created by the Plan, as is often the case for health information in our records, or you ask to amend a record that is already accurate and complete. If we deny your request to amend, we will notify you in writing. You then have the right to submit to us a written statement of disagreement with our decision and we have the right to rebut that statement.

Right to an Accounting of Disclosures by the Plan. You have the right to request an accounting of disclosures we have made of your PHI. The list will not include our disclosures related to your treatment, our payment or health care operations, or disclosures made to you or with your authorization. The list may also exclude certain other disclosures, such as for national security purposes.

Your request for an accounting of disclosures must be made in writing and must state a time period for which you want an accounting. This time period may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first accounting that you request within a 12-month period will be free. For additional lists within the same time period, we may charge for providing the accounting, but we will tell you the cost in advance.

Right to Request Restrictions on the Use and Disclosure of Your PHI. You have the right to request that we restrict or limit how we use or disclose your PHI for treatment, payment or health care operations. We may not agree to your request. If we do agree, we will comply with your request unless the information is needed for an emergency. Your request for a restriction must be made in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit how we use or disclose your information, or both; and (3) to whom you want the restrictions to apply.

Right to Receive Confidential Communications. You have the right to request that we use a certain method to communicate with you about the Plan or that we send Plan information to a certain location if the communication could endanger you. Your request to receive confidential communications must be made in writing. Your request must clearly state that all or part of the communication from us could endanger you. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice. You have a right at any time to request a paper copy of this Notice, even if you had previously agreed to receive an electronic copy.

Contact Information for Exercising Your Rights. You may exercise any of the rights described above by contacting our privacy office. See the end of this Notice for the contact information.

HEALTH INFORMATION SECURITY It is Community Health Group’s policy that all its personnel and agents must preserve the confidentiality of health, medical, and other sensitive information pertaining to Community Health Group members and employees in accordance with applicable laws, accreditation standards, and professional ethics. Community Health Group requires its employees to follow Community Health Group’s confidentiality policies and procedures that limit access to health information about members to those employees who need it to perform their job responsibilities. In addition, Community Health Group maintains physical, administrative and technical security measures to safeguard your protected health information, whether in oral, written, or electronic form.

Handling PHI Files and documents containing PHI are either shredded or secured in filing cabinets. In high-traffic areas, PHI should never be left out in the open unattended. All Electronic PHI data is located in data folders that have limited access using Windows user authentication. Access to these folders is determined based on the user’s job responsibilities. An E-mail containing PHI should be encrypted before sending outside of Community Health Group Email messages leaving the plan domain have a disclaimer that states the message may contain PHI and should be handled accordingly.


We reserve the right to change the terms of this Notice at any time, effective for protected health information that we already have about you as well as any information that we receive in the future. We will provide you with a copy of the new Notice whenever we make a material change to the privacy practices described in this Notice. Any time we make a material change to this Notice, we will promptly revise and issue the new Notice with the new effective date. We will also post it on our website. COMPLAINTS If you believe Community Health Group has violated your privacy rights set out in this notice, you may file a complaint with Community Health Group or the Secretary of Health and Human Services. For more information on filing a complaint with Community Health Group, please refer to the section of the Member Guide that addresses member grievances.

Contact information

If you have questions about this notice, or wish to file a complaint, call or write:

Community Health Group

ATTN: Compliance Officer

2420 Fenton Street, Suite 100

Chula Vista, CA 91914

Phone: (619) 498-6490

Fax: (619) 422-5930  


The U.S. Department of Health and Human Services

To file a complaint with the Secretary of Health and Human Services, call or write:

The U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Washington, D.C. 20201

Toll Free: 1-877-696-6775

We support your right to protect the privacy of your protected health information. We will not retaliate against you or penalize you for filing a complaint.