PRIVACY POLICY

Notice of Privacy Practices for Protected Health Information

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

Simplefill is dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information.

Simplefill is required by law to abide by the terms of this Notice.

We reserve the right to change the terms of this Notice, making any revision applicable to all the protected health information we maintain. If Simplefill revises the terms of this Notice, it will post a revised notice. Simplefill will make paper copies of this Notice of Privacy Practice for Protected Health Information available upon request.

How Your Medical Information Will Be Used and Disclosed:

Simplefill will use your medical information as part of rendering our prescription assistance services and functioning as a health care advocate. For example, your medical information may be used by the health care professional assisting you, by the business office to process your payment for the services rendered and by administrative personnel reviewing the quality and appropriateness of the service you received.

Simplefill may also use and/or disclose your information in accordance with federal and state laws for the following purposes:

 

• Simplefill advocates may contact you to provide appointment reminders or information about service alternatives or other health-related benefits and services that may be of interest to you.
• Simplefill may use your personal and/or medical information to make referrals for other related services you may have requested or may have been recommended to you.
• Simplfill may disclose medical information when required by the United States Department of Health and Human Services as part of an investigation or determination of the Company's compliance with relevant laws.
• Unless you object, Simplefill may disclose your medical information to a Family member, Guardian, Power of Attorney or Health Care Surrogate as related to the services being rendered if deemed necessary to complete process for which services have been requested.
• Simplefill may disclose your medical information in the course of certain judicial or administrative proceedings as required by law.
• Simplefill will not use or disclose your medical information for any other purpose without your written authorization. Once given, you may revoke your authorization in writing at any time.

Your Rights Regarding Your Protected Health Information:

You have the following rights with respect to your protected health information:

 

• The right to request restrictions on certain uses and disclosures of your medical information.
• The right to receive communications from Company in a confidential manner.
• The right to inspect and copy your medical information.
• The right to request an amendment of your medical information.
• The right to receive an accounting of the disclosures of your medical information made by Company.
• The right to request a paper copy of this Notice of Privacy Practices for Protected Health Information.
• The right to complain to Company and/or to the United State Department of Health and Human Services if you believe that the Company has violated your privacy rights.

For questions regarding this policy , please contact Simplefill's Privacy Officer at (877) 827-2897 or

This Privacy Notice was developed and is used by Simplefill as part of its HIPAA compliance efforts.

Notice is Effective January 1, 2008.

CANCELLATION POLICY

You may cancel the service any time after enrollment with a minimum of 14 days notice in writing prior to the next billing cycle as banking systems require advance notice. For our patients' protection, we would never want to cancel someone out of our program and stop processing their refills without written notification from the patient. Please submit written cancellation notice including the patient's address, telephone, social security number (to verify we are cancelling the correct person), reason for cancelling, and the patient's signature to your Personal Advocate.

IMPORTANT: Do not attempt to cancel by revoking charges to your account as you will be held responsible for fees we incur and your service fees due prior to receipt of your written cancellation.

REFUND POLICY

Because we care, we would not want you to pay for our service if we cannot save you money. Assuming all your provided information was complete and accurate, we will refund your money if you do not qualify for the PAP programs that result in a savings for you. To request a refund submit all your denial letters from the pharmaceutical companies involved within 120 days of enrolling in our program to your Personal Advocate.

IMPORTANT: Do not revoke charges to your account as you will be held responsible for fees we incur.