Common use of PLEASE REVIEW IT CAREFULLY Clause in Contracts

PLEASE REVIEW IT CAREFULLY. This Notice is effective as of September 03, 2013. We (Blue Cross and Blue Shield of Florida, Inc., d/b/a/ Florida Blue and Health Options, Inc., d/b/a Florida Blue HMO, collectively referred to as Florida Blue in this Notice) understand the importance of, and are committed to, maintaining the privacy of your protected health information (PHI). PHI is health and nonpublic personal financial information that can reasonably be used to identify you and that we maintain in the normal course of either administering your employer’s self-insured group health plan or providing you with insured health care coverage and other services. PHI also includes your personally identifiable information that we may collect from you in connection with the application and enrollment process for health insurance coverage. We are required by applicable federal and state laws to maintain the privacy of your PHI. We are also required to provide you with this Notice which describes our privacy practices, our legal duties, and your rights concerning your PHI. We are required to follow the privacy practices that are described in this Notice while it is in effect. We reserve the right to change our privacy practices and the terms of this Notice at any time and to make the terms of our revised Notice effective for all of your PHI that we either currently maintain or that we may maintain in the future. If we make a significant change in our privacy practices, we will post a revised Notice on our web site by the effective date, and provide the revised Notice, or information about the change and how to get the revised Notice, to covered individuals in our next annual mailing. How we protect your PHI:  Our employees are trained on our privacy and data protection policies and procedures;  We use administrative, physical and technical safeguards to help maintain the privacy and security of your PHI;  We have policies and procedures in place to restrict our employees’ use of your PHI to those employees who are authorized to access this information for treatment or payment purposes or to perform certain healthcare operations; and  Our corporate Business Ethics, Integrity & Compliance division monitors how we follow our privacy policies and procedures. How we must disclose your PHI:  To You: We will disclose your PHI to you or someone who has the legal right to act on your behalf (your personal representative) in order to administer your ‘Individual Rights’ under this Notice.  To The Secretary of the Department of Health and Human Services (HHS): We will disclose your PHI to HHS, if necessary, to ensure that your privacy rights are protected.  As Required by Law: We will disclose your PHI when required by law to do so. How we may use and disclose your PHI without your written authorization: We may use and disclose your PHI without your written authorization in a number of different ways in connection with your treatment, the payment for your health care, and our health care operations. When using or disclosing your PHI, or requesting your PHI from another entity, we will make reasonable efforts to limit such use, disclosure or request, to the extent practicable, to the minimum necessary to accomplish the intended purpose of such use, disclosure or request. The following are only a few examples of the types of uses and disclosures of your PHI that we may make without your written authorization.  For Treatment: We may use and disclose your PHI as necessary to aid in your treatment or the coordination of your care. For example, we may disclose your PHI to doctors, dentists, hospitals, or other health care providers in order for them to provide treatment to you.  For Payment: We may use and disclose your PHI to administer your health benefits policy or contract. For example, we may use and disclose your PHI to pay claims for services provided to you by doctors, dentists or hospitals. We may disclose your PHI to a health care provider or another health plan so that the provider or plan may obtain payment of a claim or engage in other payment activities.  To Family, Friends, and Others for Treatment or Payment: Our disclosure of your PHI for the treatment and payment purposes described above may include disclosures to others who are involved in your care or the administration of your health benefits policy or contract. For example, we may disclose your PHI to your family members, friends or caregivers if you direct us to do so or if we exercise professional judgment and determine that they are involved in either your care or the administration of your health benefits policy. We may send an explanation of benefits to the policyholder, which may include claims paid and other information. We may determine that persons are involved in your care or the administration of your health benefits policy if you either agree or fail to object to a disclosure of your PHI to such persons when given an opportunity. In an emergency or in situations where you are incapacitated or not otherwise present, we may disclose your PHI to your family members, friends, caregivers or others, when the circumstances indicate that such disclosure is authorized by you and is in your best interests. In these situations we will only disclose your PHI that is relevant to such other person’s involvement in your care or the administration of your health benefits policy.

PLEASE REVIEW IT CAREFULLY. This Notice is effective as of September 03, 2013. We (Blue Cross and Blue Shield of Florida, Inc., d/b/a/ Florida Blue and Health Options, Inc., d/b/a Florida Blue HMO, collectively referred to as Florida Blue in this Notice) understand the importance of, and are committed to, maintaining the privacy of your protected health information (PHI). PHI is health and nonpublic personal financial information that can reasonably be used to identify you and that we maintain in the normal course of either administering your employer’s self-insured group health plan or providing you with insured health care coverage and other services. PHI also includes your personally identifiable information that we may collect from you in connection with the application and enrollment process for health insurance coverage. We are required by applicable federal and state laws to maintain the privacy of your PHI. We are also required to provide you with this Notice which describes our privacy practices, our legal duties, and your rights concerning your PHI. We are required to follow the privacy practices that are described in this Notice while it is in effect. We reserve the right to change our privacy practices and the terms of this Notice at any time and to make the terms of our revised Notice effective for all of your PHI that we either currently maintain or that we may maintain in the future. If we make a significant change in our privacy practices, we will post a revised Notice on our web site by the effective date, and provide the revised Notice, or information about the change and how to get the revised Notice, to covered individuals in our next annual mailing. How we protect your PHI:  • Our employees are trained on our privacy and data protection policies and procedures;  • We use administrative, physical and technical safeguards to help maintain the privacy and security of your PHI;  • We have policies and procedures in place to restrict our employees’ use of your PHI to those employees who are authorized to access this information for treatment or payment purposes or to perform certain healthcare operations; and  • Our corporate Business Ethics, Integrity & Compliance division monitors how we follow our privacy policies and procedures. How we must disclose your PHI:  • To You: We will disclose your PHI to you or someone who has the legal right to act on your behalf (your personal representative) in order to administer your ‘Individual Rights’ under this Notice.  • To The Secretary of the Department of Health and Human Services (HHS): We will disclose your PHI to HHS, if necessary, to ensure that your privacy rights are protected.  • As Required by Law: We will disclose your PHI when required by law to do so. How we may use and disclose your PHI without your written authorization: We may use and disclose your PHI without your written authorization in a number of different ways in connection with your treatment, the payment for your health care, and our health care operations. When using or disclosing your PHI, or requesting your PHI from another entity, we will make reasonable efforts to limit such use, disclosure or request, to the extent practicable, to the minimum necessary to accomplish the intended purpose of such use, disclosure or request. The following are only a few examples of the types of uses and disclosures of your PHI that we may make without your written authorization.  For Treatment: We may use and disclose your PHI as necessary to aid in your treatment or the coordination of your care. For example, we may disclose your PHI to doctors, dentists, hospitals, or other health care providers in order for them to provide treatment to you.  For Payment: We may use and disclose your PHI to administer your health benefits policy or contract. For example, we may use and disclose your PHI to pay claims for services provided to you by doctors, dentists or hospitals. We may disclose your PHI to a health care provider or another health plan so that the provider or plan may obtain payment of a claim or engage in other payment activities.  To Family, Friends, and Others for Treatment or Payment: Our disclosure of your PHI for the treatment and payment purposes described above may include disclosures to others who are involved in your care or the administration of your health benefits policy or contract. For example, we may disclose your PHI to your family members, friends or caregivers if you direct us to do so or if we exercise professional judgment and determine that they are involved in either your care or the administration of your health benefits policy. We may send an explanation of benefits to the policyholder, which may include claims paid and other information. We may determine that persons are involved in your care or the administration of your health benefits policy if you either agree or fail to object to a disclosure of your PHI to such persons when given an opportunity. In an emergency or in situations where you are incapacitated or not otherwise present, we may disclose your PHI to your family members, friends, caregivers or others, when the circumstances indicate that such disclosure is authorized by you and is in your best interests. In these situations we will only disclose your PHI that is relevant to such other person’s involvement in your care or the administration of your health benefits policy.

PLEASE REVIEW IT CAREFULLY. This Notice is effective as of September 03, 2013. We (Blue Cross and Blue Shield of Florida, Inc., d/b/a/ Florida Blue and Health Options, Inc., d/b/a Florida Blue HMO, collectively referred to as Florida Blue in this Notice) understand the importance of, and are committed to, maintaining the privacy of your protected health information (PHI). PHI is health and nonpublic personal financial information that can reasonably be used to identify you and that we maintain in the normal course of either administering your employer’s self-insured group health plan or providing you with insured health care coverage and other services. PHI also includes your personally identifiable information that we may collect from you in connection with the application and enrollment process for health insurance coverage. We are required by applicable federal and state laws law to maintain protect the privacy of medical information about you and that identifies you. This medical information may be information about healthcare we provide to you or payment for healthcare provided to you. It may also be information about your PHIpast, present, or future medical condition. We are also required by law to provide you with this Notice which describes our privacy practices, of Privacy Practices explaining our legal duties, duties and your rights concerning your PHIprivacy practices with respect to medical information. We are legally required to follow the privacy practices terms of this Notice. In other words, we are only allowed to use and disclose medical information in the manner that are we have described in this Notice. We may change the terms of this Notice while it is in effectthe future. We reserve the right to change our privacy practices and the terms of this Notice at any time make changes and to make the terms of our revised new Notice effective for all of your PHI medical information that we either currently maintain or that we may maintain in the futuremaintain. If we make a significant change changes to the Notice, we will: • Post the new Notice in our privacy practices, we will post a revised Notice on our web site by the effective date, and provide the revised Notice, or information about the change and how to get the revised Notice, to covered individuals in our next annual mailingcommon waiting areas. How we protect your PHI:  Our employees are trained on our privacy and data protection policies and procedures;  We use administrative, physical and technical safeguards to help maintain the privacy and security of your PHI;  We have policies and procedures in place to restrict our employees’ use of your PHI to those employees who are authorized to access this information for treatment or payment purposes or to perform certain healthcare operations; and  Our corporate Business Ethics, Integrity & Compliance division monitors how we follow our privacy policies and procedures. How we must disclose your PHI:  To You: We will disclose your PHI to you or someone who has the legal right to act on your behalf (your personal representative) in order to administer your ‘Individual Rights’ under this Notice.  To The Secretary • Have copies of the Department new Notice available upon request. (Please contact the facility Privacy Officer to obtain a copy of Health and Human Services our current Notice at: King (HHS): We will disclose your PHI to HHS, if necessary, to ensure that your privacy rights are protected.  As Required by Law715) 258- 5586; Union Grove (000) 000-0000; Chippewa Falls (000) 000-0000.) The rest of this Notice will: We will disclose your PHI when required by law to do so. How • Discuss how we may use and disclose medical information about you. • Explain your PHI without your written authorization: rights with respect to medical information about you. • Describe how and where you may file a privacy-related complaint. If, at any time, you have questions about information in this Notice or about our privacy policies, procedures or practices, you can contact the facility Privacy Officer. WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU IN SEVERAL CIRCUMSTANCES We may use and disclose your PHI without your written authorization medical information about members every day. This section of our Notice explains in a number of different ways in connection with your treatment, the payment for your health care, and our health care operations. When using or disclosing your PHI, or requesting your PHI from another entity, we will make reasonable efforts to limit such use, disclosure or request, to the extent practicable, to the minimum necessary to accomplish the intended purpose of such use, disclosure or request. The following are only a few examples of the types of uses and disclosures of your PHI that we may make without your written authorization.  For Treatment: We may use and disclose your PHI as necessary to aid in your treatment or the coordination of your care. For example, we may disclose your PHI to doctors, dentists, hospitals, or other health care providers in order for them to provide treatment to you.  For Payment: We may use and disclose your PHI to administer your health benefits policy or contract. For example, some detail how we may use and disclose your PHI medical information about you in order to pay claims for services provided to you by doctorsprovide healthcare, dentists or hospitals. We may disclose your PHI to a health care provider or another health plan so that the provider or plan may obtain payment of a claim or engage in other payment activities.  To Family, Friendsfor that healthcare, and Others for Treatment operate our business efficiently. This section then briefly mentions several other circumstances in which we may use or Payment: Our disclosure of your PHI for the treatment and payment purposes described above may include disclosures to others who are involved in your care or the administration of your health benefits policy or contractdisclose medical information about you. For examplemore information about any of these uses or disclosures, we may disclose your PHI to your family membersor about any of our privacy policies, friends procedures or caregivers if you direct us to do so or if we exercise professional judgment and determine that they are involved in either your care or practices, contact the administration of your health benefits policy. We may send an explanation of benefits to the policyholder, which may include claims paid and other information. We may determine that persons are involved in your care or the administration of your health benefits policy if you either agree or fail to object to a disclosure of your PHI to such persons when given an opportunity. In an emergency or in situations where you are incapacitated or not otherwise present, we may disclose your PHI to your family members, friends, caregivers or others, when the circumstances indicate that such disclosure is authorized by you and is in your best interests. In these situations we will only disclose your PHI that is relevant to such other person’s involvement in your care or the administration of your health benefits policyfacility Privacy Officer.