Notice of Privacy Practices

1Your Rights — Overview

When it comes to your health information, you have certain rights. This notice describes those rights and some of our responsibilities to help you exercise them.

2Your Choices

You have some choices in the way that we use and share information as we:

• Answer coverage questions from your family and friends
• Provide disaster relief
• Market our services and sell your information

For certain health information, you can tell us your choices about what we share. If you have a clear preference, talk to us — tell us what you want us to do and we will follow your instructions.

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. If you are unable 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, or when needed to lessen a serious and imminent threat to health or safety.

3Our Uses & Disclosures — Overview

We may use and share your information as we:

• Help manage the health care treatment you receive
• Run our organization
• Pay for your health services
• Help with public health and safety issues
• Do research
• Comply with the law
• Address law enforcement and other government requests
• Respond to lawsuits and legal actions

See Section 12 for a full description of our permitted uses and disclosures.

4Get a Copy of Health and Claims Records

You can ask to see or get a copy of your health and claims records and other health information we have about you. Contact us to learn how to submit your request.

We will provide a copy or a summary of your health and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

5Ask Us to Correct Health and Claims Records

You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Contact us to learn how to submit your request.

We may say "no" to your request, but we will tell you why in writing within 60 days.

6Request Confidential Communications

You can ask us to contact you in a specific way (for example, by home or office phone) or to send mail to a different address.

We will consider all reasonable requests, and must say "yes" if you tell us that you would be in danger if we do not accommodate your request.

7Ask Us to Limit What We Use or Share

You can ask us not to use or share certain health information for treatment, payment, or our operations.

We are not required to agree to your request, and we may say "no" if it would affect your care.

8Get a List of Those With Whom We've Shared Information

You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We'll provide one accounting per year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

9Get a Copy of This Privacy 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.

10Choose 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.

11File a Complaint If You Feel Your Rights Are Violated

You can complain if you feel we have violated your privacy rights by contacting us at the information listed in Section 15.

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:

• Mail: 200 Independence Avenue, S.W., Washington, D.C. 20201
• Phone: 1-877-696-6775
• Online: www.hhs.gov/ocr/privacy/hipaa/complaints/

12How We Typically Use or Share Your Health Information

Routine Uses

Other Permitted Uses

We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in law before we can share your information for these purposes. For more information, visit www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help With Public Health and Safety Issues

We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone's health or safety

Do Research

We can use or share your information for health research, subject to applicable legal requirements.

Comply With the Law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.

Address Law Enforcement and Government Requests

We can use or share health information about you:

• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law

Respond to Lawsuits and Legal Actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

13Our Responsibilities

• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time — let us know in writing if you change your mind.

For more information, visit www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

14Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. Each version of the Notice will have an effective date listed on the first page.

We will post any material changes to our website and, where required by law, notify you directly.

15Contact Us

If you have any questions about this Notice or your privacy rights, please contact us: