Privacy Policy

Privacy Practices for Protected Health Information (PHI)

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Please review it carefully. The privacy of your information is important to us.

Our Legal Duty

This Notice of Privacy Practices describes how Champion may use and disclose health information about you (your “protected health information” or “PHI”) to carry out payment activities, healthcare operations, and for other purposes that are permitted or required by law.

We are required by applicable federal and state laws to maintain the privacy of your PHI. We comply with HIPAA—the Health Insurance Portability and Accountability Act of 1996—and with applicable state privacy laws (such as California’s CMIA and CPRA, or similar laws in other states) whenever they provide greater protection.

We must give you this Notice about our privacy practices, our legal duties, and your rights concerning your PHI. If your unsecured PHI is compromised, we will notify you as required by federal and state standards.

This Notice became effective on October [x], 2025 and remains in effect until Champion issues a new version. We can change the terms of this Notice at any time, and the changes will apply to all information we have about you. The new Notice will be available on our website, and we will mail a paper copy to you upon your request.

Organizations Covered by this Notice

This Notice applies to the privacy practices of Champion Health, as well as our business associates and vendors who may create, receive, maintain, or transmit PHI on our behalf under Business Associate Agreements.

Other healthcare providers (for example, your physician, hospital, or pharmacy) may have their own privacy notices describing how they handle PHI.

Our Uses and Disclosures of Your PHI

We use and disclose PHI about you for treatment, payment, and healthcare operations. Such uses and disclosures do not require your written authorization. When using or disclosing your information, we share only the minimum necessary PHI to accomplish the purpose.

Champion maintains administrative, technical, and physical safeguards—including encryption, access controls, and workforce training—to protect your PHI in all formats (paper, electronic, and verbal).

For Treatment: We may share information about your prescriptions or medical history with your doctor to support your care.

For Payment: We may use or disclose PHI to pay claims, determine eligibility for benefits, or issue explanations of benefits.

For Healthcare Operations: We may use or disclose PHI to conduct quality assessments, credential providers, coordinate care, manage cases, or support enrollment and benefits administration.

Other purposes for using and disclosing your PHI which do not require your written authorization include:

• To Communicate with You: We may contact you for customer service or to provide information you request.
• To Family and Friends: We may disclose PHI to family members, friends, or others involved in your care or payment for care, if you agree or if we believe it is in your best interest in an emergency. We will disclose PHI to your personal representative when properly designated under applicable law.
• To Comply with the Law: We will disclose your PHI when required to do so by applicable law.
• For Public Health and Safety Activities: We may disclose your PHI for certain situations such as reporting suspected abuse, neglect, or violence.
• For Health Oversight Activities: We may disclose your PHI to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure.
• For Legal Activities: We may disclose your PHI in response to a court or administrative order; a subpoena; a workers’ compensation claim; a law enforcement request; or in connection with special government functions such as military, national security, and presidential protective services. If you are or become an inmate of a correctional institution, we may disclose your PHI to the institution or its agents for your health and the health and safety of others.

We also comply with any state laws that impose stricter limits than HIPAA.

Use of Artificial Intelligence and Automated Tools

Champion may use secure artificial intelligence (AI) or other automated technologies to support certain health plan and operational activities, including:
– Analyzing data to improve care coordination, detect fraud or abuse, and enhance member services
– Supporting customer service through virtual assistants or chat tools
– Assisting authorized staff with clinical or claims-related decision support

When we use AI or automated tools:
– These technologies do not replace professional medical judgment.
– Only the minimum necessary PHI is used, consistent with HIPAA and applicable laws.
– PHI processed by AI systems is protected by the same safeguards that apply to all PHI.
– We monitor AI systems for accuracy, fairness, and bias, and limit access to authorized personnel.
– You may request information about how AI or automated tools were used in managing your information or benefits.

Champion does not sell, lease, or share PHI analyzed by AI systems for marketing or other non-permitted purposes.

Use of Medicare “Blue Button” Data

Champion may provide you with the option to connect your Medicare claims data through the CMS Blue Button 2.0 API. Champion will use this data to better understand your health history (as well as to help your healthcare providers better understand your health history).  When you choose to share your Medicare information with Champion:
– You must authenticate through Medicare.gov and explicitly authorize Champion or another third-party application to access your Medicare Part A, B, or D claims data.
– Before granting access, you will be shown CMS’s Blue Button 2.0 Application Programming Interface (API) Terms of Service and explaining how the data will be used, stored, shared, and protected.
– You have the right to limit or revoke access at any time. If you revoke access, no new data will be retrieved from CMS, and we will honor your preferences regarding retention or deletion of previously shared data.
– We use only the minimum data necessary for the purpose you authorize, and we protect it with the same administrative, technical, and physical safeguards that apply to other PHI.
– We do not sell or share Medicare data obtained via Blue Button for marketing or other non-permitted purposes.
– Our use of Blue Button data is subject to CMS program requirements, HIPAA, the Privacy Act of 1974, and applicable state privacy laws.

Other Uses and Disclosures

Any use or disclosure of PHI not described in this Notice requires your written authorization. You may revoke an authorization at any time in writing, except to the extent we have already relied on it. A separate authorization is required for the sale of PHI and most marketing communications. Please note that we do not create or maintain psychotherapy notes.

Your Rights Regarding PHI

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

– Inspect and Copy: You may view or obtain copies of PHI we use to make decisions about your healthcare or payment. Electronic copies are available if readily producible.
– Amend: If you believe your PHI is incorrect or incomplete, you may request an amendment with supporting reasons. We may say “no” to your request, but we will tell you why in writing within 60 days.
– Accounting of Disclosures: You may request a list of certain disclosures of PHI made in the past six years (excluding those for treatment, payment, or healthcare operations, as well as those you asked us to make) and why such disclosures were made. We will provide one accounting a year for free but may charge a reasonable, cost-based fee if you ask for another one within 12 months.
– Request Restrictions: You may ask us to limit how we use or disclose PHI for payment or operations; we are not required to agree but will honor approved restrictions unless needed for emergency care.
– Confidential Communications: If disclosure to your usual address, phone number, or email address could endanger you, you may request alternative contact methods or locations. We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

– Request a Copy of this Notice:  You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will provide you with a paper copy promptly.

– Choose Someone to Act For You:  If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

All requests must be submitted in writing to the address at the end of this Notice. Forms are available on request.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in payment for your care
• Share information in a disaster relief situation

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information

Questions and Complaints

If you have questions about this Notice, our privacy practices, our use of emerging technologies (including AI), or our handling of Blue Button data, contact us at the address below.

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Contact Information

Champion Health Privacy & Compliance Officer
PO Box 15337
Long Beach, CA 90815

Phone: 1-800-885-8000 (TTY 711)
Fax: 1-949-998-9856
Email: Hotline@championpayer.com

Last Updated: October 2, 2025