Website Privacy Policy

CalOptima collects personal information and non-personally identifiable information from visitors and users of the CalOptima Websites. Personal Information as used in this Policy includes Personally Identifiable Information (“PII”), defined by applicable federal and state laws, which is generally information that can be used to distinguish or trace an individual's identity, as well as protected health information, or “PHI” as defined by the Health Insurance Portability and Accountability Act of 1996 known as “HIPAA.” Read more about our HIPAA privacy practices related to PHI here.

 

A. Anonymous Information

For users of the CalOptima Websites, CalOptima may automatically collect and temporarily store non-personally identifiable information about you which does not identify you individually, but can provide CalOptima with usage data, either individually or in the aggregate. CalOptima refers to this information as Anonymous Information, and it includes:

• The IP address used to access the Internet;
• The date and time of visit;
• The pages visited;
• The search terms used to locate the CalOptima Websites, if visited from a search engine;
• The IP address and/or name of the previous website, if visited via a link; and
• Geolocation information

B. Personal Information

CalOptima collects Personal Information, which is unique to you and you may voluntarily provide, during the registration process and through our services on the CalOptima Websites.

Member Portal

• Name, Medi-Cal ID, and birthdate;
• Email address and phone number;
• User name, password, and answers to security questions;
• Member’s health network and primary care physician;
• Preferred written and spoken languages;
• Communications between you and CalOptima staff;
• Health assessment survey responses;
• Nature of grievance/complaint, when completing Grievance and Appeals forms; and
• Any other information about your health that you input into the Member Portal.

www.caloptima.org

• Name, mailing address, and birthdate;
• Other contact information, such as email address and/or telephone number;
• Plan information, such as Member ID Number, also known as Medi-Cal ID number (CIN) and Medicare ID number (MBI), and information about other health insurance coverage;
• Member eligibility and demographics;
• Member health network and PCP;
• Provider information, such as name, address, tax ID, and contracted health networks;
• Preferred written and spoken languages;
• Geolocation information;
• Nature of grievance/complaint, when completing Grievance and Appeals forms
• Health care information, including but not limited to:
  • Medical history, including treatment and prescription history and referrals;
  • Communications between you and CalOptima staff;
  • Health assessment survey responses; and
  • Any other information about your health that you input into the CalOptima Websites.

C. Information About You From Social Networking Sites and Other Software On Your Device

CalOptima maintains profiles and/or pages on various social media sites, including Facebook, LinkedIn, Twitter, and Instagram. If you choose to “Like” or “Follow” CalOptima on Facebook, “Follow” CalOptima on Twitter or Instagram, or connect with CalOptima on LinkedIn, or take any other similar action on another social media site, you are providing your consent to receive information updates, including solicitations from CalOptima. To stop receiving this information from CalOptima on a social media site, you must follow the procedure established by the site. For example, on Twitter, you must click “Unfollow” on CalOptima’s profile.

D. Technical and Usage Information From Your Devices

CalOptima may collect and store information about your mobile device or computer system, including a Media Access Control (MAC) address and IP address. CalOptima may also collect usage statistics about your interactions with the CalOptima Websites. This information is typically collected through the use of server log files or web log files (“Log Files”), mobile device software development kits and tracking technologies like browser cookies to collect and analyze certain types of technical information. Some of the cookies CalOptima places on your computer are linked to your user ID.
 

E. Information from Communications Features and Online Tools

You may be able to communicate and share information with CalOptima employees. This includes messaging and submission of online forms, including Grievance and Appeal forms and Requests for New Member ID Cards. CalOptima may record and store these communications on our servers. You acknowledge and consent to the recording and storage of these communications.
 

F. Other Sources

CalOptima may collect or receive information from other sources including, without limitation: (i) other users of CalOptima Websites, and (ii) third party information vendors. This information may be combined with other information about you that we collect.

CalOptima uses your Personal Information, as described above, for a variety of purposes; however, any Personal Information that you give us will only be used to provide the product, service, or information you have requested (for example, to allow you to share information about your health care provider, or for you to make a complaint). We may use your Personal Information for the following purposes:

• Operating and delivering health care services;
• Enhancing, improving, or modifying our services;
• Authenticating or confirming your identity;
• Verifying user eligibility;
• Providing you access to your member and CalOptima benefits information;
• Allowing you to search for health care providers, pharmacies, and facilities;
• Allowing you to send messages to CalOptima employees to facilitate your health care services;
• Completing transactions, such as processing your health care provider’s request for Drug Prior Authorization;
• Allowing you to use self-service online tools, such as the Request for a New Member ID Card;
• Allowing you to file complaints against CalOptima, including Grievances and Appeals;
• Sending you information about health care and health related services, resources and benefits that will help you manage your health;
• Sending administrative information to you, for example, information regarding the services and changes to our terms, conditions, and policies;
• Providing and improving customer services, including through email or text communications, or any chat or similar feature available through our services;
• Sending you health surveys;
• Improving user satisfaction, through data analysis, and identifying usage trends on the CalOptima Websites
• Sending marketing information we think may be of interest to you as permitted by applicable laws;
• Taking any action that we believe to be necessary or appropriate:
  • To investigate, prevent and detect illegal activities under applicable laws, including laws outside your country of residence;
  • To comply with legal process;
  • To respond to requests from public and government authorities including public and government authorities outside your country of residence;
  • To enforce our Terms of Service and Privacy Policy;
  • To protect our operations or those of our affiliates;
  • To protect our rights, privacy, safety or property, and/or that of our affiliates, you or others; and
• Other purposes specifically disclosed at the time we request your information.

CalOptima may also aggregate Personal Information so that it does not personally identify you or any other user of the Services (for example, we may aggregate Personal Information to analyze the percentage of our users who have a particular area code). CalOptima may also remove Personal Information to create anonymous data. CalOptima uses and shares anonymous and aggregate information for historical, statistical, or business planning purposes. Additionally, we may use and share this information for any purpose except where we are required to do otherwise under applicable law. If we are required to treat this information as Personal Information under applicable law, then we may use it for the purposes for which we use and share Personal Information.
 

CalOptima may disclose your Personal Information as described above as permitted by, required by, and/or in accordance with applicable law, including, without limitation, (a) to your physician, pharmacy, and/or other health care provider; (b) to persons and/or entities authorized by you in writing; (c) to third parties who perform services on our behalf, such as a pharmacy benefits manager, pharmacy benefits tools, and others; and/or (d) as requested by regulatory agencies, such as the California Department of Health Care Services (DHCS) or The Centers for Medicare and Medicaid Services (CMS). Please note that if you post content, communicate with other users and/or comment on content, such information may be exposed publicly.

CalOptima may also disclose your Personal Information after it has been de-identified to third parties to the extent permitted by and/or in accordance with applicable law. CalOptima may permit other persons or entities to gain access to collections and/or compilations of your data that has been de-identified in accordance with applicable laws. We may share de-identified, aggregated information and certain technical information to develop analytics to the extent permitted by our state and federal regulators and applicable law. We may also use this information for behavioral and web analytics to the extent permitted by our state and federal regulators and applicable law.

CalOptima may disclose or report information about you as permitted by, required by, and/or in accordance with applicable law: (i) if we have a good faith belief that we are required to disclose the information in response to legal process (for example, a court order, search warrant or subpoena); (ii) to satisfy applicable laws, (iii) if we believe that the CalOptima Websites are being used to commit a crime, including, without limitation, to report such criminal activity or to exchange information with other companies and organizations for the purposes of fraud protection and credit risk reduction, (iv) if we have a good faith belief that there is an emergency that poses a threat to the health or safety of a person or the general public, and/or (v) in order to protect the rights or property of CalOptima.

CalOptima protects the Personal Information it has collected from you by using industry standard security precautions against loss and unauthorized access, destruction, use, modification or disclosure of that information. CalOptima complies with the Health Insurance Portability and Accountability Act (“HIPAA”) security requirements applicable to CalOptima as a covered entity and as a business associate (as defined in HIPAA).

To help prevent unauthorized access, maintain data accuracy, and protect against the inappropriate use of the information we collect, store, and transmit, CalOptima has implemented a range of technical, physical and administrative safeguards. Under applicable laws, we are required to apply reasonable and appropriate measures to safeguard the confidentiality, integrity, and availability of the personal health information (PHI) we use, maintain, store and/or disclosure as part of the services we provide. These measures include encryption, mutual authentication, protection against malware/spyware, firewalls, and token authentication, among other safeguards.

To further safeguard your information, you are required to register for an account to access the Member Portal. You will be asked to create a user name and create a password, and to provide information pertinent to your account. You are responsible for securing the confidentiality of your user name and password. When choosing a password, select a combination of letters and numbers that isn't able to be guessed or discovered by someone who knows you. It is important that you protect and maintain the security of your account, and that you immediately notify us of any unauthorized use of your account.

Even though CalOptima takes precautions to maintain the confidentiality of your information, it is important to keep in mind that any information that you input or message that you send using the CalOptima Websites or by e-mail or other means may not be secure and may be susceptible to third party interception. No website, mobile application or Internet transmission, however, is completely secure. Unauthorized access, hacking, data loss, and/or other data breaches or other type of misuse may occur. If such events occur, we must comply with notice and other requirements under HIPAA and State privacy laws.
 

CalOptima Websites do not respond to “Do Not Track” signals from browsers. CalOptima Websites do not utilize advertisements, cross-channel campaign management, third party trackers, personalized advertisements, or other information collection technologies regardless of “Do Not Track” browser settings.

The CalOptima Websites are not intended for use by children under the age of 18, and we do not knowingly collect any personal information from such children unless a parent, legal guardian, or personal representative provides such information on behalf of the child. Children under the age of 18 should not use the CalOptima Websites at any time, and only a parent, legal guardian, or personal representative should use CalOptima Websites on their behalf. If we learn that we have collected Personal Information from a child under the age of 18 without having received it from such child’s parent, legal guardian, or personal representative, we will delete such information. You can visit the Federal Trade Commission’s website to learn about the Children’s Online Privacy Protection Act (COPPA).

The downloading, republication, retransmission, reproduction or other use of images, videos, and other licensed or copyrighted material from this website as stand-alone files is prohibited. The people in the licensed photos and videos that appear on this website are models and used for illustrative purposes only.

This website uses Google Noto and Font Awesome Free open source fonts licensed under the SIL Open Font License, Version 1.1.
 

You may request to review, correct, update, suppress, or delete your PII previously provided to CalOptima by using the contact information below:

CalOptima Customer Service Department
1-714-246-8500
Toll-free at 1-888-587-8088
TDD/TTY: 1-800-735-2929

We will respond to your request consistent with applicable law. We may need to verify your identity prior to implementing your request. Please be as clear as possible in making your request and make it clear what PII you would like to have changed, suppressed, or otherwise limited. Please note that we may need to retain certain information for recordkeeping purposes and/or to complete any transactions that you began prior to requesting a change or deletion. There may also be residual information that will remain within our databases and other records, which will not be removed.

Should you wish to make changes to your PHI, please note that we comply with requirements under HIPAA to allow amendments to your PHI in the Designated Record Set as defined by HIPAA and our privacy policies.

If you would like to submit a comment, complaint, or question related to this Privacy Policy, you may contact the CalOptima’s Privacy Officer at:

505 City Parkway West Orange, CA 92868

1-888-587-8088