HPI Member ID Card and Privacy Practices Guide

Welcome to Health Plans, Inc.

Health Plans, Inc. (HPI) is your plan administrator, and we're thrilled to serve you. This guide will help you understand your new member ID card and your privacy rights under federal law.

Understanding Your Member ID Card

What's Included on Your Card

Your HPI member ID card contains essential information you'll need when visiting healthcare providers or filling prescriptions:

ID and group numbers - Your unique identification for claims processing
Covered members - Names of all family members covered under your plan
Provider network(s) - Which doctors and facilities accept your plan
Copayment amounts - What you pay at the time of service
Out-of-pocket maximum - The most you'll pay for covered services in a plan year (after reaching this amount, your plan pays 100% of covered benefits)
Prescription drug plan details - Information about your pharmacy benefits
Customer Service contact information - Phone number and website for questions
Claim submission details - Where providers send claims for payment

Using Your Member ID Card

Important: Show your new HPI member ID card to your healthcare providers at every visit and when filling prescriptions. This ensures they have your current plan information on file.

Keep your card with you at all times and store it in a safe, accessible place like your wallet.

Getting Help with Your Plan

If you have questions about your plan benefits, coverage, or eligibility:

Call the phone number on the back of your member ID card
Visit the website listed on the back of your card
Write to: Health Plans, Inc., 1500 West Park Drive, Suite 330, Westborough, MA 01581

Your Privacy Rights Under HIPAA

HPI and your employer's group health plan are committed to protecting your personal and health information under the Health Insurance Portability and Accountability Act (HIPAA).

What Information Is Protected

Personal and Health Information (PHI) includes:

Your name and social security number
Health information related to your physical or behavioral health
Information used in providing healthcare or payment for services
All forms: electronic, written, and verbal communications

How Your Information May Be Used

Your health plan may use and disclose your information without your authorization for:

Payment Purposes

Processing and paying claims for services you receive
Determining eligibility and benefits
Conducting utilization review and medical necessity reviews
Coordinating benefits with other insurance
Handling appeals and external reviews

Healthcare Operations

Care management and coordination
Quality assessment and improvement programs
Cost analyses and premium rate calculations
Wellness programs and preventive health initiatives
Disease management and case management programs
General administrative activities and auditing

Treatment Coordination

Sharing information with your doctors, hospitals, and other healthcare providers
Coordinating your care between multiple providers
Providing clinical reminders to your primary care physician

Who May Receive Your Information

The plan may share your information with:

Business Associates - Third-party administrators (like HPI) and other service providers who help manage your benefits

Your Family and Others - In emergency situations, or when you've designated someone as your personal representative, or when they're involved in your care or payment

Your Healthcare Providers - For quality initiatives, safety, coordination of care, and treatment purposes

Your Employer (Plan Sponsor) - Only for plan administration purposes (never for employment decisions or actions)

Other Permitted Parties - Public health authorities, government oversight agencies, law enforcement (when required by law), and researchers (under strict privacy protections)

Special Privacy Protections

Reproductive Health Information

Your plan cannot use or disclose reproductive health information for criminal, civil, or administrative proceedings against you when the healthcare was lawful where it was provided. This includes information about abortion services, contraception, and other reproductive care.

Substance Use Disorder Information

Records from substance use disorder treatment programs have extra protections and generally cannot be disclosed without your written consent or a court order.

Genetic Information

Your plan will not use or disclose genetic information for underwriting purposes.

Your Individual Privacy Rights

You have the following rights regarding your health information:

Access Your Records - Request and receive copies of your health information (electronic or paper format available)

Amend Your Information - Request corrections if you believe information is incorrect or incomplete

Confidential Communications - Request to receive communications at alternative locations or by alternative means

Accounting of Disclosures - Request a list of when your information was disclosed (for the past 6 years)

Request Restrictions - Ask the plan to limit how it uses or discloses your information (the plan isn't required to agree but will honor restrictions if accepted)

Name a Personal Representative - Designate someone to make healthcare privacy decisions on your behalf

Receive This Notice - Get a paper copy of privacy practices at any time

Breach Notification - Be notified if your unsecured information is breached

When Authorization Is Required

The plan must obtain your written authorization before:

Using your information for marketing purposes
Selling your information
Using psychotherapy notes (in most cases)
Using substance use disorder information for fundraising
Any use or disclosure not described in the privacy notice

You can revoke any authorization at any time in writing.

Sharing Information Without Your Consent

In certain situations, the plan may be required by law to disclose your information:

To report abuse, neglect, or domestic violence
To prevent serious threats to health or safety
For national security purposes
To correctional institutions for inmates
For workers' compensation claims
In response to court orders or subpoenas (with special protections for reproductive health and substance use information)

How to Exercise Your Privacy Rights

To exercise any of your privacy rights:

Contact your Employer's Privacy Officer for assistance
If HPI administers all your benefits, you may need to contact HPI directly
Complete any required forms provided by the Privacy Officer

Filing a Privacy Complaint

If you believe your privacy rights have been violated:

Contact HPI:

Mail: Health Plans, Inc., ATTN: Privacy Officer, PO Box 5199, Westborough, MA 01581
Compliance Hotline: (888) 892-9102
Customer Service: Phone number on your HPI ID card

Contact Federal Authorities:

File a complaint with the U.S. Department of Health and Human Services (HHS)
Visit: www.hhs.gov/ocr for more information

Important: The plan will not take retaliatory action against you for filing a complaint.

Important Contact Information

Health Plans, Inc. (HPI)

Address: 1500 West Park Drive, Suite 330, Westborough, MA 01581
Mailing Address: PO Box 5199, Westborough, MA 01581
Phone: 800-532-7575
Website: www.hpiTPA.com

For Customer Service: Use the phone number and website on the back of your member ID card

Spanish Notice: Una versión en español del Aviso de prácticas de privacidad está disponible en www.hpiTPA.com (seleccione Member/Miembro, luego My Plan/Mi plan)

Updates to Privacy Practices

This privacy notice is effective as of June 10, 2025. The plan may update this notice at any time, as long as changes comply with state and federal law. You'll be notified of important changes by mail or electronically, and updated notices will be posted on the plan website.

For the most current information, always refer to the materials provided with your member ID card and visit www.hpiTPA.com.