Common use of CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION Clause in Contracts

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official P.O. Box 272540 Chico, CA 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxx@xxxxxxxxxxxx.xxx

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official P.O. Box 272540 Chico, CA 00000-0000 Toll-Free Telephone: 0- : 0-000-000-0000 xxxxxxx@xxxxxxxxxxxx.xxx

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may The confidential communications request shall be contact us at: valid until the subscriber submits a revocation of‌‌ Blue Shield of California Privacy Official P.O. Box 272540 Chico, CA 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxx@xxxxxxxxxxxx.xxx

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidenti- ality/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able identi- fiable information, such as your name, address, tele- phone telephone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield's policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access ac- cess to your personal and health information, you may contact us at: Blue Shield of California Privacy Official P.O. Box 272540 Chico, CA 00000-0000 Toll-Free Telephone:0000 0- 000-000-0000 xxxxxxx@xxxxxxxxxxxx.xxxxxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. copy.‌‌ If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official P.O. Box 272540 Chico, CA 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxx@xxxxxxxxxxxx.xxx

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ity/privacy of your personal and health infor- mation. Personal and health information includes both medical information and individually identifi- able information, such as your name, address, tele- phone number, or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. copy.‌ If you are concerned that Blue Shield may have vi- olated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official P.O. Box 272540 Chico, CA 00000-0000 Toll-Free Telephone: 0- 000-000-0000 xxxxxxx@xxxxxxxxxxxx.xxx

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able identifiable information, such as your name, address, tele- phone telephone number, or social security numberSocial Security Number. Blue Shield of California will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S ’S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUEST. Blue Shield’s Shield of California's policies and procedures regarding our confidentiality/privacy practices are contained in the “"Notice of Privacy Practices”", which you may obtain by either by calling the Customer Service Department Member Services at the telephone number indicated on your Identification Cardlisted in the back of this booklet, or by accessing Blue Shield of California’s internet 's Internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield of California may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Correspondence Address:‌ Blue Shield of California Privacy Official P.O. P. O. Box 272540 Chico, CA 00000-0000 Toll-Free Telephone: 0- : 0-000-000-0000 xxxxxxx@xxxxxxxxxxxx.xxxE-mail Address:‌ XxxxXxxxxxxx_Xxxxxxx@xxxxxxxxxxxx.xxx

CONFIDENTIALITY OF PERSONAL AND HEALTH INFORMATION. Blue Shield of California protects the confidential- ityconfidentiality/privacy of your personal and health infor- mationinformation. Personal and health information includes both medical information and individually identifi- able identifiable information, such as your name, address, tele- phone number, telephone number or social security number. Blue Shield will not disclose this information without your authorization, except as permitted by law. A STATEMENT DESCRIBING BLUE SHIELD'S POLICIES AND PROCEDURES FOR PRESERVING THE CONFIDENTIALITY OF MEDICAL RECORDS IS AVAILABLE AND WILL BE FURNISHED TO YOU UPON REQUESTstatement describing Blue Shield’s policies and procedures for preserving the confidentiality of medical records is available and will be furnished to you upon request. Blue Shield’s policies and procedures regarding our confidentiality/privacy practices are contained in the “Notice of Privacy Practices”, which you may obtain either by calling the Customer Service Department at the telephone number indicated on your Identification Card, or by accessing Blue Shield of California’s internet site located at xxxx://xxx.xxxxxxxxxxxx.xxx and printing a copy. If you are concerned that Blue Shield may have vi- olated violated your confidentiality/privacy rights, or you disagree with a decision we made about access to your personal and health information, you may contact us at: Blue Shield of California Privacy Official P.O. Box 272540 Chico, CA 00000-0000 Toll0-Free Telephone: 0- 000-000-0000 xxxxxxx@xxxxxxxxxxxx.xxxxxxxxxxxxxxx_xxxxxxx@xxxxxxxxxxxx.xxx