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Privacy Notice Statement

The Health Insurance Exchange (HIE) was established by the Department of Health and Human Services and operated by the Centers for Medicare and Medicaid Services (CMS) under Section 1321(c)(1) of the Affordable Care Act to help individuals obtain health insurance. Eligible individuals and small businesses can use the HIE to compare and buy health insurance based on price, benefits and quality.

Legal Authority: Eligibility Screening Services, LLC has been designated by CMS as a certified entity that can assist you with the enrollment and application process. Eligibility Screening Services, LLChas certified application counselors who will help you obtain the information that you request regarding the health insurance products that are available. If you choose to enroll, these counselors can assist you with the enrollment process. You will be required to sign an authorization indicating that you would like Eligibility Screening Services, LLC to assist you with your enrollment. You will not be charged a fee for this assistance. Furthermore, you are not required to use a counselor to enroll in an HIE.

Purpose of the Information Collection: As part of the application process, the counselors will request that you provide confidential information. The collection of this information is necessary to determine your eligibility for insurance programs in the HIE.

Disclosure of Information: Your information will be disclosed to Federal and/or State government HIE’s so that your health care insurance needs can be assessed and compared with the plans offered by qualified heath care insurance providers.

Authorized Use and Disclosure: The information that you provide to the counselors may only be used or disclosed to the extent required for the purpose of assisting you with the application and enrollment in the HIE. If the counselor creates any paper documents as part of the application process, those documents will be destroyed when the enrollment is completed. If you provide any paper documents to the counselor, those documents will be returned to you or destroyed. If Eligibility Screening Services, LLC decides to use your information for other defined purposes, you will be asked to sign a specific authorization for these purposes.

Revision of Privacy Notice Statement: The Privacy Notice Statement will be reviewed annually and a revised notice will be published if changes are made to the notice or to any corresponding policies and procedures.

Privacy and Security Practices: Eligibility Screening Services, LLC has adopted and enforces appropriate policies and procedures to safeguard the confidentiality of your information.

Filing a Complaint: If you have a complaint regarding the use and disclosure of your information, please contact the Eligibility Screening Services, LLC Privacy Officer at (615) 465-7068. The Privacy Officer can also provide the contact information if you want to submit a complaint to CMS.