HIPAA PRIVACY POLICY

Health Care Operations

Activities related to Dr. Holbert’s operations, including but not limited to:

• claim transmission
• customer issue resolution

Payment

Transmission or processing of claims.

Protected Health Information

Information relating to a patient’s past, present or future health or condition, the provision of health care to a patient, or payment for the provision of health care to a patient. Protected Health Information includes, but is not limited to:

• patient name
• Social Security number/member ID
• service date
• diagnosis information
• claim information

Treatment

The provision, coordination or management of vision care and related services by one or more vision care providers.

III. PRIVACY PRACTICES

How Dr. Holbert Uses and Discloses Information About You

(a) Personally Identifiable Information:

(i)     We use information collected from and about you, individually or combined, to facilitate use of the Site, process your purchases and related payments, communicate with you, respond to your inquiries and requests, conduct surveys, carry out research and analysis relating to our products and services, improve our products and services, and, as permitted by law, for marketing and promotional purposes. From time to time, we may send users administration communications about our services (for example, if you lose your password or if changes are made to the terms of the services or our privacy notice). Because this information is important to your interaction with and our provision of the Site, you may not opt-out of receiving such communications. We may also give you the option of receiving marketing communications about new products, services and promotions from Dr. Holbert, our affiliates and subsidiaries, or other third parties. If you choose to receive such marketing communications, we will share your contact information with the applicable third parties for this purpose. We may enhance or merge the information that we collect with data obtained from third parties, in which case the combined information will be treated in accordance with this Privacy Notice.

(ii)     Third Party Channel Partners. On occasion we partner with third parties to deliver complementary or supplemental services to you. In those circumstances, we will make it very clear to you that the third party channel partner is the entity collecting your information and not Dr. Holbert, and you will have a choice whether to provide information to them. As such, any data you provide to them would be subject to their privacy and security practices and Dr. Holbert will not be responsible for the information you provide to them or their privacy and security practices. An example hereof is the Virtual Try-On tool available on our Site. In order to provide you with this service, we have partnered with Ditto Technologies Inc.

Click here to learn more about Ditto’s privacy practices.

(iii)     Affiliate Sharing. Subject to the terms of this Privacy Notice, in the normal course of performing services, and as permitted by applicable law, we may share your information with our affiliates, subsidiaries, or divisions. For example, Dr. Holbert collects and shares certain information with www.vsp.com to provide personalized features such as eligibility information of your VSP vision care benefit.

(iv)     Sharing with Other Users. Certain features of our Site may enable you to connect and communicate with other Site users (“Friends”). By participating in any sharing program, your information (including any personal information you provided, and any information obtained from the Site) may be made available to those Friends. Some Site sharing programs allow you to publish information in a forum, or transmit communications to Friends. Any information you choose to provide in these areas can be read or used by other users. You are solely responsible for any information that you choose to share. Your participation in these features and your sharing of your information with us and other users constitutes your agreement to such sharing. Please take care when using these features.

(v)     Children. Dr. Holbert doesn’t sell products for purchase by children. We sell children’s products for purchase by adults. If you’re under 18, you may use Dr. Holbert only with the involvement of a parent or guardian.

(b) Protected Health Information:

Dr. Holbert will only use and disclose your PHI without your authorization when necessary for:

• coordination of your vision care treatment
• disclosure to your plan sponsor to the extent permitted by law
• payment
• health care operations, or
• as required or permitted by law (please see “Use or Disclosure Required or Permitted by Law” section).

Disclosure To Dr. Holbert’s Business Associates

Dr. Holbert will only disclose your PHI to Business Associates who have agreed in writing to maintain the privacy of PHI as required by law.

Use Or Disclosure Requiring Authorization

Dr. Holbert will not use or disclose your PHI for purposes other than those described in this notice. If it becomes necessary to disclose any of your PHI for other reasons, Dr. Holbert will request your written authorization. Dr. Holbert will obtain your authorization for any sale of PHI, to use or disclose your PHI for marketing. Revoking Authorization: If you provide written authorization, you may revoke it at any time in writing, except to the extent that Dr. Holbert has relied upon the authorization prior to its being revoked.

Use Or Disclosure Required Or Permitted By Law

Dr. Holbert may use or disclose your Protected Health Information to the extent that the law requires the use or disclosure:

• Public Health: For public health activities or as required by the public health authority.
• Health Oversight: To a health oversight agency for activities such as audits, investigations and inspections. Oversight agencies include, but are not limited to, government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
• Legal Proceedings: In response to an order of a court or administrative tribunal, in response to a subpoena, discovery request or other lawful process.
• Law Enforcement: For law enforcement purposes, including:
  – legal process or as otherwise required by law;
  – limited information requests for identification and location;
  – use or disclosure related to a victim of a crime;
  – suspicion that death has occurred as a result of criminal conduct;
  – if a crime occurs on Dr. Holbert’s premises; or
  – in a medical emergency where it is likely that a crime has occurred.
• Criminal Activity: As requested by law enforcement authorities, if the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Use And Disclosure Examples

• Payment: Dr. Holbert uses Protected Health Information for payment processing to verify that services provided were covered under the patient’s vision care plan.
• Health Care Operations: Dr. Holbert uses and discloses Protected Health Information to audit and review claims payment activity to ensure that claims were paid correctly.
• Treatment: To coordinate treatment by a health care provider.

Personal Representative

Dr. Holbert may disclose your Protected Health Information to a person who has legal authority to make health care decisions on your behalf.

Disclosure Requiring Opportunity To Object

Dr. Holbert may disclose your Protected Health Information to a family member, friend, or other person involved in your care or payment if the information is relevant to their involvement and you have agreed or had an opportunity to object.

Genetic Information

Dr. Holbert is prohibited from using or disclosing your genetic information for underwriting purposes.

KNOW YOUR RIGHTS

Exercising Your Rights

You may exercise any of your below rights by sending us a written request.

Review Your PII or PHI

You have a right to inspect and obtain a copy of your PII or PHI.
Important: If you feel your PII or PHI is incomplete or incorrect, you have the right to request that it be amended.

Request to Restrict Your PHI

You can request restrictions on the use and disclosure of your PHI. Dr. Holbert is not required to agree to a requested restriction.

Example: If a restriction request prevents us from providing service to you or from performing payment related functions, we will not be able to agree to the request.

Confidential Communication

When necessary, Dr. Holbert may seek to contact you by calling you at your home or by sending mailings containing your Protected Health Information to your home. If you feel that such communications could compromise your safety, you may request in writing an alternate communication method and/or location.

Accounting of Disclosures

If a disclosure of your Protected Health Information was made for a reason other than treatment, payment or health care operations, you have a right to receive an accounting of the disclosure.

Important: If the disclosure was made to you, Dr. Holbert will not provide an accounting.

Receive a Copy of Complaints

You can view and print a copy of this Privacy Notice through Eyeconic.com. If you believe that your privacy rights have been violated, you may submit a complaint to Dr. Holbert or to the U.S. Secretary of Health and Human Services at any time. Dr. Holbert will not retaliate against you for filing a complaint. You may file a complaint with Dr. Holbert at Eyeconic.com.