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Privacy Act Statement
This statement serves to inform you of the purpose for collecting personal information required by this system of records and how it will be used.
AUTHORITY: 10 U.S.C. Chapter 55 – Medical and Dental Care; 32 CFR 199.17 – TRICARE Program; and E.O. 9397 (SSN), as amended.
PURPOSE: To collect information from Military Health System beneficiaries in order to determine their eligibility for coverage under the TRICARE Program; to issue payment upon establishment of eligibility; to determine that the service/supplies received are authorized by law; and to check or correct records with respect to your Medicare and/or Other Health Insurance (OHI) coverage.
ROUTINE USES: Any protected health information (PHI) in your records may be used and disclosed generally as permitted by the HIPAA Privacy Rule (45 CFR Parts 160 and 164), as implemented within DoD. Permitted uses and disclosures of PHI include, but are not limited to, treatment, payment, and healthcare operations.
Use and disclosure of your records outside of DoD may also occur in accordance with the DoD Blanket Route Uses published at http://dpclo.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx and as permitted by the Privacy Act of 1974, as amended (5 U.S.C. 552a(b)).
DISCLOSURE: Disclosure is voluntary; however, failure to provide information will result in delay in payment or may result in denial of claim.
Consent to monitoring
This computer system, which includes all related equipment, networks, and network devices (specifically including access to the Internet) are provided only for authorized business functions. The system may be monitored by authorized personnel to ensure that their use is authorized, for management of the system, to facilitate protection against unauthorized access, and to verify security procedures. Information you place on this system is not private. Use of this computer system, authorized or unauthorized. constitutes consent to official monitoring of this system.
Privacy act warning
Information contained in this system with respect to Wisconsin Physicians Insurance Company is subject to the Privacy Act of 1974. Information contained in this system may be used only by authorized persons in the conduct of official business. Any individual responsible for unauthorized disclosure of misuse of personal information my be subject to fines of up to $5,000.