Notice of Privacy Practice

Your Information, Your Rights, Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Notice of Privacy Practices

Blue Shield Promise Health Plan (Care1st Health Plan until 12/31/2018) Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Information. Your Rights. Our Responsibilities.

Your Rights

You have the right to:

Your Choices

You have some choices in the way that we use and share information as we:

Our Uses and Disclosures

We may use and share your information as we

Your Rights

When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities to help you.

Get a copy of your health and claims records

Ask us to correct health and claims records

Request confidential communications

Ask us to limit what we use or share

Get a list of those with whom we've shared information

Get a copy of this privacy notice

Choose someone to act for you

File a complaint if you feel your rights are violated

Your Choices

For certain health information, you can tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

Our Uses and Disclosures

How do we typically use or share your health information?
We typically use or share your health information in the following ways.

Help manage the health care treatment you receive

Run our organization

Pay for your health services

Administer your plan

How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the 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. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

Do research

Comply with the law

Respond to organ and tissue donation requests and work with a medical examiner or funeral director

Address workers' compensation, law enforcement, and other government requests

Respond to lawsuits and legal actions

Specific Types of medical information:

There are stricter requirements for use and disclosure of some types of information - for example, mental health and drug and alcohol abuse patient information, and HIV test results. However, there are still circumstances in which these types of information may be used or disclosed without your authorization.

Abuse or Neglect:

By law, we may disclose your medical information to the appropriate authority to report suspected elderly abuse or neglect to identify suspected victims of abuse, neglect, or domestic violence.


Under the federal law that requires us to give you this notice, inmates do not have the same rights to control their medical information as other individuals. If you are an inmate of a correctional institution or in custody of a law enforcement official, we may disclose your medical information to the correctional institution or the law enforcement for certain purposes, for example, to protect your health or safety or someone else's.

All Other Uses and Disclosures of your Medical Information Require Your Prior Written Authorization:

Except for those uses and disclosures described above, we will not use or disclose your medical information without your written authorization. When your authorization is required and you authorized us to use or disclose your medical information for some purpose, you may revoke that authorization by notifying us in writing at any time. Please note that the revocation will not apply to any authorized use or disclosure of your medical information that took place before we received your revocation.

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health information
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information
  • We must follow the duties and privacy practices described in this notice and give you a copy of it
  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

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: 09/23/2013

If you have questions about this notice, or want to lodge a complaint about our privacy practices, please let us know by calling our Customer Care Operations at 1-800-544-0088 (TTY: 711), 8 a.m. to 8 p.m., seven days a week, from Oct. 1st – Mar. 31st and 8 a.m. – 8 p.m. weekdays, from Apr. 1st – Sept. 30th, or call Blue Shield Promise Health Plan's Hotline at 1-877-837-6057. You may also write to our Privacy Office at:

Blue Shield Promise Health Plan (Care1st Health Plan until 12/31/2018)
Attention: Privacy Office
601 Potrero Grande Drive
Monterey Park, CA 91755
or email to the Blue Shield Promise Health Plan's (Care1st Health Plan until 12/31/2018) Privacy Office at HIPAAPrivacy@care1st.com or call our Privacy Hotline at 1-800-232-5587, TTY: 711.

You may also file a complaint and notify:

Department of Health Care Services (DHCS) Privacy Officer: privacyofficer@dhcs.ca.gov, phone: 916-445- 4646, Fax: 1-916-440-7680. Address: C/O Office of HIPAA Compliance DHCS, P.O. Box 997413, MS 4722, Sacramento, CA 95899-7413. Website: www.privacy.ca.gov

We will not take retaliatory action against you if you file a complaint about our privacy practices.

Download this Privacy Policy