Common use of PRIVACY AND CONFIDENTIALITY STATEMENT Clause in Contracts

PRIVACY AND CONFIDENTIALITY STATEMENT. We understand the importance of keeping your personal and health information private (PHI). PHI includes both medical information and individually identifiable information, such as your name, address, telephone number or social security number. We are required by applicable federal and state law to maintain the privacy of your PHI. Under both law and our policies, we have a responsibility to protect the privacy of your PHI. We: • Protect your privacy by limiting who may see your PHI; • Limit how we may use or disclose your PHI; • Inform you of our legal duties with respect to your PHI; • Explain our privacy policies; and • Strictly adhere to the policies currently in effect. We reserve the right to change our privacy practices at any time, as allowed by applicable law, rules and regulations. We reserve the right to make changes in our privacy practices for all PHI that we maintain, including information we created or received before we made the changes. When we make a significant change in our privacy practices, we will send notice to our health plan subscribers. For more information about our privacy practices, please contact us. As a covered person, we may use and disclose you PHI, without your consent/authorization, in the following ways: Treatment: we may disclose your PHI to a health care practitioner, a hospital or other entity which asks for it in order for you to receive medical treatment. Payment: we may use and disclose your PHI to pay claims for covered services provided to you by health care practitioners, hospitals or other entities. We may use and disclose your PHI to conduct other health care operations activities. It has always been our goal to ensure the protection and integrity of your personal and health information. Therefore, we will notify you of any potential situations where your identification would be used for reasons other than treatment, payment and health plan operations. Notice of Privacy Practices for your personal health and financial information 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 personal and health information is important. You don't need to do anything unless you have a request or complaint. Relationships are built on trust. One of the most important elements of trust is respect for an individual’s privacy. We at Humana value our relationship with you, and we take your personal privacy seriously. This notice explains Humana’s privacy practices, our legal responsibilities, and your rights concerning your personal and health information. We follow the privacy practices described in this notice and will notify you of any changes. We reserve the right to change our privacy practices and the terms of this notice at any time, as allowed by law. This includes the right to make changes in our privacy practices and the revised terms of our notice effective for all personal and health information we maintain. This includes information we created or received before we made the changes. When we make a significant change in our privacy practices, we will change this notice and send the notice to our health plan subscribers. What is personal and health information? Personal and health information - from now on referred to as “information” - includes both medical information and individually identifiable information, like your name, address, telephone number, or Social Security number. The term “information” in this notice includes any personal and health information created or received by a healthcare provider or health plan that relates to your physical or mental health or condition, providing healthcare to you, or the payment for such healthcare. How does Humana protect my information? In keeping with federal and state laws and our own policy, Humana has a responsibility to protect the privacy of your information. We have safeguards in place to protect your information in various ways including: • Limiting who may see your information • Limiting how we use or disclose your information • Informing you of our legal duties about your information • Training our associates about company privacy policies and procedures How does Humana use and disclose my information? We must use and disclose your information: • To you or someone who has the legal right to act on your behalf • To the Secretary of the Department of Health and Human Services • Where required by law. We have the right to use and disclose your information: • To a doctor, a hospital, or other healthcare provider so you can receive medical care • For payment activities, including claims payment for covered services provided to you by healthcare providers and for health plan premium payments • For healthcare operation activities including processing your enrollment, responding to your inquiries and requests for services, coordinating your care, resolving disputes, conducting medical management, improving quality, reviewing the competence of healthcare professionals, and determining premiums • For performing underwriting activities • To your plan sponsor to permit them to perform plan administration functions • To contact you with information about health-related benefits and services, appointment reminders, or about treatment alternatives that may be of interest to you • To your family and friends if you are unavailable to communicate, such as in an emergency GN14474HH 209 Notice of Privacy Practices (continued) • To provide payment information to the subscriber for Internal Revenue Service substantiation • To public health agencies if we believe there is a serious health or safety threat • To appropriate authorities when there are issues about abuse, neglect, or domestic violence • In response to a court or administrative order, subpoena, discovery request, or other lawful process • For law enforcement purposes, to military authorities and as otherwise required by law • To assist in disaster relief efforts • For compliance programs and health oversight activities • To fulfill Humana’s obligations under any workers’ compensation law or contract • To avert a serious and imminent threat to your health or safety or the health or safety of others • For research purposes in limited circumstances • For procurement, banking, or transplantation of organs, eyes, or tissue • To a coroner, medical examiner, or funeral director. Will Humana use my information for purposes not described in this notice? In all situations other than described in this notice, Humana will request your written permission before using or disclosing your information. You may revoke your permission at any time by notifying us in writing. We will not use or disclose your information for any reason not described in this notice without your permission. What does Humana do with my information when I am no longer a Humana member or I do not obtain coverage through Humana? Your information may continue to be used for purposes described in this notice when your membership is terminated or you do not obtain coverage through Humana. After the required legal retention period, we destroy the information following strict procedures to maintain the confidentiality. What are my rights concerning my information? The following are your rights with respect to your information: • Access – You have the right to review and obtain a copy of your information that may be used to make decisions about you, such as claims and case or medical management records. You also may receive a summary of this health information. If you request copies, we may charge you a fee for each page, a per hour charge for staff time to locate and copy your information, and postage. • Alternate Communications – You have the right to receive confidential communications of information in a different manner or at a different place to avoid a life-threatening situation. We will accommodate your request if it is reasonable. • Amendment – You have the right to request an amendment of information we maintain about you if you believe the information is wrong or incomplete. We may deny your request if we did not create the information, we do not maintain the information, or the information is correct and complete. If we deny your request, we will give you a written explanation of the denial. • Disclosure – You have the right to receive a listing of instances in which we or our business associates have disclosed your information for purposes other than treatment, payment, health plan operations, and certain other activities. Effective April 1, 2003 or whenever you became a Humana member, Humana began maintaining these types of disclosures and will maintain this information for a period of six years. If you request this list more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. • Notice – You have the right to receive a written copy of this notice any time you request. • Restriction – You have the right to ask to restrict uses or disclosures of your information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement. You also have the right to agree to or terminate a previously submitted restriction. Notice of Privacy Practices (continued) How do I exercise my rights or obtain a copy of this notice? All of your privacy rights can be exercised by obtaining the applicable privacy rights request forms. You may obtain any of the forms by: • Contacting us at 0-000-000-0000 at any time • Accessing our Website at Xxxxxx.xxx and going to the Privacy Practices link • E-mailing us at privacy xxxxxx@xxxxxx.xxx Send completed request form to: Humana Privacy Xxxxxx X.X. Xxx 0000 Xxxxxxxxxx, XX 00000 What should I do if I believe my privacy has been violated? If you believe your privacy has been violated in any way, you may file a complaint with Human by calling us at: 0-000-000-0000 any time. You may also submit a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights (OCR). We will give you the appropriate OCR regional address on request. You also have the option to e-mail your complaint to XXXXxxxxxxxx@xxx.xxx. We support your right to protect the privacy of your personal and health information. We will not retaliate in any way if you elect to file a complaint with us or with the U.S. Department of Health and Human Services.

PRIVACY AND CONFIDENTIALITY STATEMENT. We understand the importance of keeping your personal and health information private (PHI). PHI includes both medical information and individually identifiable information, such as your name, address, telephone number or social security number. We are required by applicable federal and state law to maintain the privacy of your PHI. Under both law and our policies, we have a responsibility to protect the privacy of your PHI. We: • Protect your privacy by limiting who may see your PHI; • Limit how we may use or disclose your PHI; • Inform you of our legal duties with respect to your PHI; • Explain our privacy policies; and • Strictly adhere to the policies currently in effect. We reserve the right to change our privacy practices at any time, as allowed by applicable law, rules and regulations. We reserve the right to make changes in our privacy practices for all PHI that we maintain, including information we created or received before we made the changes. When we make a significant change in our privacy practices, we will send notice to our health plan subscribers. For more information about our privacy practices, please contact us. As a covered person, we may use and disclose you PHI, without your consent/authorization, in the following ways: Treatment: we may disclose your PHI to a health care practitioner, a hospital or other entity which asks for it in order for you to receive medical treatment. Payment: we may use and disclose your PHI to pay claims for covered services provided to you by health care practitioners, hospitals or other entities. We may use and disclose your PHI to conduct other health care operations activities. It has always been our goal to ensure the protection and integrity of your personal and health information. Therefore, we will notify you of any potential situations where your identification would be used for reasons other than treatment, payment and health plan operations. Notice of Privacy Practices for your personal health and financial information 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 personal and health information is important. You don't need to do anything unless you have a request or complaint. Relationships are built on trust. One of the most important elements of trust is respect for an individual’s privacy. We at Humana value our relationship with you, and we take your personal privacy seriously. This notice explains Humana’s privacy practices, our legal responsibilities, and your rights concerning your personal and health information. We follow the privacy practices described in this notice and will notify you of any changes. We reserve the right to change our privacy practices and the terms of this notice at any time, as allowed by law. This includes the right to make changes in our privacy practices and the revised terms of our notice effective for all personal and health information we maintain. This includes information we created or received before we made the changes. When we make a significant change in our privacy practices, we will change this notice and send the notice to our health plan subscribers. What is personal and health information? Personal and health information - from now on referred to as “information” - includes both medical information and individually identifiable information, like your name, address, telephone number, or Social Security number. The term “information” in this notice includes any personal and health information created or received by a healthcare provider or health plan that relates to your physical or mental health or condition, providing healthcare to you, or the payment for such healthcare. How does Humana protect my information? In keeping with federal and state laws and our own policy, Humana has a responsibility to protect the privacy of your information. We have safeguards in place to protect your information in various ways including: • Limiting who may see your information • Limiting how we use or disclose your information • Informing you of our legal duties about your information • Training our associates about company privacy policies and procedures How does Humana use and disclose my information? We must use and disclose your information: • To you or someone who has the legal right to act on your behalf • To the Secretary of the Department of Health and Human Services • Where required by law. We have the right to use and disclose your information: • To a doctor, a hospital, or other healthcare provider so you can receive medical care • For payment activities, including claims payment for covered services provided to you by healthcare providers and for health plan premium payments • For healthcare operation activities including processing your enrollment, responding to your inquiries and requests for services, coordinating your care, resolving disputes, conducting medical management, improving quality, reviewing the competence of healthcare professionals, and determining premiums • For performing underwriting activities • To your plan sponsor to permit them to perform plan administration functions • To contact you with information about health-related benefits and services, appointment reminders, or about treatment alternatives that may be of interest to you • To your family and friends if you are unavailable to communicate, such as in an emergency GN14474HH 209 Notice of Privacy Practices (continued) • To provide payment information to the subscriber for Internal Revenue Service substantiation • To public health agencies if we believe there is a serious health or safety threat • To appropriate authorities when there are issues about abuse, neglect, or domestic violence • In response to a court or administrative order, subpoena, discovery request, or other lawful process • For law enforcement purposes, to military authorities and as otherwise required by law • To assist in disaster relief efforts • For compliance programs and health oversight activities • To fulfill Humana’s obligations under any workers’ compensation law or contract • To avert a serious and imminent threat to your health or safety or the health or safety of others • For research purposes in limited circumstances • For procurement, banking, or transplantation of organs, eyes, or tissue • To a coroner, medical examiner, or funeral director. Will Humana use my information for purposes not described in this notice? In all situations other than described in this notice, Humana will request your written permission before using or disclosing your information. You may revoke your permission at any time by notifying us in writing. We will not use or disclose your information for any reason not described in this notice without your permission. What does Humana do with my information when I am no longer a Humana member or I do not obtain coverage through Humana? Your information may continue to be used for purposes described in this notice when your membership is terminated or you do not obtain coverage through Humana. After the required legal retention period, we destroy the information following strict procedures to maintain the confidentiality. What are my rights concerning my information? The following are your rights with respect to your information: • Access – You have the right to review and obtain a copy of your information that may be used to make decisions about you, such as claims and case or medical management records. You also may receive a summary of this health information. If you request copies, we may charge you a fee for each page, a per hour charge for staff time to locate and copy your information, and postage. • Alternate Communications – You have the right to receive confidential communications of information in a different manner or at a different place to avoid a life-threatening situation. We will accommodate your request if it is reasonable. • Amendment – You have the right to request an amendment of information we maintain about you if you believe the information is wrong or incomplete. We may deny your request if we did not create the information, we do not maintain the information, or the information is correct and complete. If we deny your request, we will give you a written explanation of the denial. • Disclosure – You have the right to receive a listing of instances in which we or our business associates have disclosed your information for purposes other than treatment, payment, health plan operations, and certain other activities. Effective April 1, 2003 or whenever you became a Humana member, Humana began maintaining these types of disclosures and will maintain this information for a period of six years. If you request this list more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. • Notice – You have the right to receive a written copy of this notice any time you request. • Restriction – You have the right to ask to restrict uses or disclosures of your information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement. You also have the right to agree to or terminate a previously submitted restriction. Notice of Privacy Practices (continued) How do I exercise my rights or obtain a copy of this notice? All of your privacy rights can be exercised by obtaining the applicable privacy rights request forms. You may obtain any of the forms by: • Contacting us at 0-000-000-0000 at any time • Accessing our Website at Xxxxxx.xxx and going to the Privacy Practices link • E-mailing us at privacy xxxxxx@xxxxxx.xxx Send completed request form to: Humana Privacy Xxxxxx X.X. Xxx 0000 XxxxxxxxxxOffice P.O. Box 1438 Louisville, XX 00000 KY 40202 What should I do if I believe my privacy has been violated? If you believe your privacy has been violated in any way, you may file a complaint with Human by calling us at: 0-000-000-0000 any time. You may also submit a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights (OCR). We will give you the appropriate OCR regional address on request. You also have the option to e-mail your complaint to XXXXxxxxxxxx@xxx.xxx. We support your right to protect the privacy of your personal and health information. We will not retaliate in any way if you elect to file a complaint with us or with the U.S. Department of Health and Human Services.

PRIVACY AND CONFIDENTIALITY STATEMENT. We understand the importance of keeping your personal and health information private (PHI). PHI includes both medical information and individually identifiable information, such as your name, address, telephone number or social security number. We are required by applicable federal and state law to maintain the privacy of your PHI. Under both law and our policies, we have a responsibility to protect the privacy of your PHI. We: • Protect your privacy by limiting who may see your PHI; • Limit how we may use or disclose your PHI; • Inform you of our legal duties with respect to your PHI; • Explain our privacy policies; and • Strictly adhere to the policies currently in effect. We reserve the right to change our privacy practices at any time, as allowed by applicable law, rules and regulations. We reserve the right to make changes in our privacy practices for all PHI that we maintain, including information we created or received before we made the changes. When we make a significant change in our privacy practices, we will send notice to our health plan subscribers. For more information about our privacy practices, please contact us. As a covered person, we may use and disclose you PHI, without your consent/authorization, in the following ways: Treatment: we may disclose your PHI to a health care practitioner, a hospital or other entity which asks for it in order for you to receive medical treatment. Payment: we may use and disclose your PHI to pay claims for covered services provided to you by health care practitioners, hospitals or other entities. We may use and disclose your PHI to conduct other health care operations activities. It has always been our goal to ensure the protection and integrity of your personal and health information. Therefore, we will notify you of any potential situations where your identification would be used for reasons other than treatment, payment and health plan operations. Notice of Privacy Practices for your personal health and financial financial information 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 personal and health information is important. You don't need to do anything unless you have a request or complaint. Relationships are built on trust. One of the most important elements of trust is respect for an individual’s privacy. We at Humana value our relationship with you, and we take your personal privacy seriously. This notice explains Humana’s privacy practices, our legal responsibilities, and your rights concerning your personal and health information. We follow the privacy practices described in this notice and will notify you of any changes. We reserve the right to change our privacy practices and the terms of this notice at any time, as allowed by law. This includes the right to make changes in our privacy practices and the revised terms of our notice effective for all personal and health information we maintain. This includes information we created or received before we made the changes. When we make a significant change in our privacy practices, we will change this notice and send the notice to our health plan subscribers. What is personal and health information? Personal and health information - from now on referred to as “information” - includes both medical information and individually identifiable information, like your name, address, telephone number, or Social Security number. The term “information” in this notice includes any personal and health information created or received by a healthcare provider or health plan that relates to your physical or mental health or condition, providing healthcare to you, or the payment for such healthcare. How does Humana protect my information? In keeping with federal and state laws and our own policy, Humana has a responsibility to protect the privacy of your information. We have safeguards in place to protect your information in various ways including: • Limiting who may see your information • Limiting how we use or disclose your information • Informing you of our legal duties about your information • Training our associates about company privacy policies and procedures How does Humana use and disclose my information? We must use and disclose your information: • To you or someone who has the legal right to act on your behalf • To the Secretary of the Department of Health and Human Services • Where required by law. We have the right to use and disclose your information: • To a doctor, a hospital, or other healthcare provider so you can receive medical care • For payment activities, including claims payment for covered services provided to you by healthcare providers and for health plan premium payments • For healthcare operation activities including processing your enrollment, responding to your inquiries and requests for services, coordinating your care, resolving disputes, conducting medical management, improving quality, reviewing the competence of healthcare professionals, and determining premiums • For performing underwriting activities • To your plan sponsor to permit them to perform plan administration functions • To contact you with information about health-related benefits and services, appointment reminders, or about treatment alternatives that may be of interest to you • To your family and friends if you are unavailable to communicate, such as in an emergency GN14474HH 209 Notice of Privacy Practices (continued) • To provide payment information to the subscriber for Internal Revenue Service substantiation • To public health agencies if we believe there is a serious health or safety threat • To appropriate authorities when there are issues about abuse, neglect, or domestic violence • In response to a court or administrative order, subpoena, discovery request, or other lawful process • For law enforcement purposes, to military authorities and as otherwise required by law • To assist in disaster relief efforts • For compliance programs and health oversight activities • To fulfill Humana’s obligations under any workers’ compensation law or contract • To avert a serious and imminent threat to your health or safety or the health or safety of others • For research purposes in limited circumstances • For procurement, banking, or transplantation of organs, eyes, or tissue • To a coroner, medical examiner, or funeral director. Will Humana use my information for purposes not described in this notice? In all situations other than described in this notice, Humana will request your written permission before using or disclosing your information. You may revoke your permission at any time by notifying us in writing. We will not use or disclose your information for any reason not described in this notice without your permission. What does Humana do with my information when I am no longer a Humana member or I do not obtain coverage through Humana? Your information may continue to be used for purposes described in this notice when your membership is terminated or you do not obtain coverage through Humana. After the required legal retention period, we destroy the information following strict procedures to maintain the confidentiality. What are my rights concerning my information? The following are your rights with respect to your information: • Access – You have the right to review and obtain a copy of your information that may be used to make decisions about you, such as claims and case or medical management records. You also may receive a summary of this health information. If you request copies, we may charge you a fee for each page, a per hour charge for staff time to locate and copy your information, and postage. • Alternate Communications – You have the right to receive confidential communications of information in a different manner or at a different place to avoid a life-threatening situation. We will accommodate your request if it is reasonable. • Amendment – You have the right to request an amendment of information we maintain about you if you believe the information is wrong or incomplete. We may deny your request if we did not create the information, we do not maintain the information, or the information is correct and complete. If we deny your request, we will give you a written explanation of the denial. • Disclosure – You have the right to receive a listing of instances in which we or our business associates have disclosed your information for purposes other than treatment, payment, health plan operations, and certain other activities. Effective April 1, 2003 or whenever you became a Humana member, Humana began maintaining these types of disclosures and will maintain this information for a period of six years. If you request this list more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. • Notice – You have the right to receive a written copy of this notice any time you request. • Restriction – You have the right to ask to restrict uses or disclosures of your information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement. You also have the right to agree to or terminate a previously submitted restriction. Notice of Privacy Practices (continued) How do I exercise my rights or obtain a copy of this notice? All of your privacy rights can be exercised by obtaining the applicable privacy rights request forms. You may obtain any of the forms by: • Contacting us at 0-000-000-0000 at any time • Accessing our Website at Xxxxxx.xxx and going to the Privacy Practices link • E-mailing us at privacy xxxxxx@xxxxxx.xxx Send completed request form to: Humana Privacy Xxxxxx X.X. Xxx 0000 XxxxxxxxxxOffice P.O. Box 1438 Louisville, XX 00000 KY 40202 What should I do if I believe my privacy has been violated? If you believe your privacy has been violated in any way, you may file a complaint with Human by calling us at: 0-000-000-0000 any time. You may also submit a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights (OCR). We will give you the appropriate OCR regional address on request. You also have the option to e-mail your complaint to XXXXxxxxxxxx@xxx.xxx. We support your right to protect the privacy of your personal and health information. We will not retaliate in any way if you elect to file a complaint with us or with the U.S. Department of Health and Human Services.

PRIVACY AND CONFIDENTIALITY STATEMENT. We understand the importance of keeping your personal and health information private (PHI). PHI includes both medical information and individually identifiable information, such as your name, address, telephone number or social security number. We are required by applicable federal and state law to maintain the privacy of your PHI. Under both law and our policies, we have a responsibility to protect the privacy of your PHI. We: • Protect your privacy by limiting who may see your PHI; • Limit how we may use or disclose your PHI; • Inform you of our legal duties with respect to your PHI; • Explain our privacy policies; and • Strictly adhere to the policies currently in effect. We reserve the right to change our privacy practices at any time, as allowed by applicable law, rules and regulations. We reserve the right to make changes in our privacy practices for all PHI that we maintain, including information we created or received before we made the changes. When we make a significant change in our privacy practices, we will send notice to our health plan subscribers. For more information about our privacy practices, please contact us. As a covered person, we may use and disclose you PHI, without your consent/consent/ authorization, in the following ways: Treatment: we may disclose your PHI to a health care practitioner, a hospital or other entity which asks for it in order for you to receive medical treatment. Payment: we may use and disclose your PHI to pay claims for covered services provided to you by health care practitioners, hospitals or other entities. We may use and disclose your PHI to conduct other health care operations activities. It has always been our goal to ensure the protection and integrity of your personal and health information. Therefore, we will notify you of any potential situations where your identification would be used for reasons other than treatment, payment and health plan operations. Notice of Privacy Practices for your personal health and financial information 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 personal and health information is important. You don't need to do anything unless you have a request or complaint. Relationships are built on trust. One of the most important elements of trust is respect for an individual’s privacy. We at Humana value our relationship with you, and we take your personal privacy seriously. This notice explains Humana’s privacy practices, our legal responsibilities, and your rights concerning your personal and health information. We follow the privacy practices described in this notice and will notify you of any changes. We reserve the right to change our privacy practices and the terms of this notice at any time, as allowed by law. This includes the right to make changes in our privacy practices and the revised terms of our notice effective for all personal and health information we maintain. This includes information we created or received before we made the changes. When we make a significant change in our privacy practices, we will change this notice and send the notice to our health plan subscribers. What is personal and health information? Personal and health information - from now on referred to as “information” - includes both medical information and individually identifiable information, like your name, address, telephone number, or Social Security number. The term “information” in this notice includes any personal and health information created or received by a healthcare provider or health plan that relates to your physical or mental health or condition, providing healthcare to you, or the payment for such healthcare. How does Humana protect my information? In keeping with federal and state laws and our own policy, Humana has a responsibility to protect the privacy of your information. We have safeguards in place to protect your information in various ways including: • Limiting who may see your information • Limiting how we use or disclose your information • Informing you of our legal duties about your information • Training our associates about company privacy policies and procedures How does Humana use and disclose my information? We must use and disclose your information: • To you or someone who has the legal right to act on your behalf • To the Secretary of the Department of Health and Human Services • Where required by law. We have the right to use and disclose your information: • To a doctor, a hospital, or other healthcare provider so you can receive medical care • For payment activities, including claims payment for covered services provided to you by healthcare providers and for health plan premium payments • For healthcare operation activities including processing your enrollment, responding to your inquiries and requests for services, coordinating your care, resolving disputes, conducting medical management, improving quality, reviewing the competence of healthcare professionals, and determining premiums • For performing underwriting activities • To your plan sponsor to permit them to perform plan administration functions • To contact you with information about health-related benefits and services, appointment reminders, or about treatment alternatives that may be of interest to you • To your family and friends if you are unavailable to communicate, such as in an emergency GN14474HH 209 Notice of Privacy Practices (continued) • To provide payment information to the subscriber for Internal Revenue Service substantiation • To public health agencies if we believe there is a serious health or safety threat • To appropriate authorities when there are issues about abuse, neglect, or domestic violence • In response to a court or administrative order, subpoena, discovery request, or other lawful process • For law enforcement purposes, to military authorities and as otherwise required by law • To assist in disaster relief efforts • For compliance programs and health oversight activities • To fulfill Humana’s obligations under any workers’ compensation law or contract • To avert a serious and imminent threat to your health or safety or the health or safety of others • For research purposes in limited circumstances • For procurement, banking, or transplantation of organs, eyes, or tissue • To a coroner, medical examiner, or funeral director. Will Humana use my information for purposes not described in this notice? In all situations other than described in this notice, Humana will request your written permission before using or disclosing your information. You may revoke your permission at any time by notifying us in writing. We will not use or disclose your information for any reason not described in this notice without your permission. What does Humana do with my information when I am no longer a Humana member or I do not obtain coverage through Humana? Your information may continue to be used for purposes described in this notice when your membership is terminated or you do not obtain coverage through Humana. After the required legal retention period, we destroy the information following strict procedures to maintain the confidentiality. What are my rights concerning my information? The following are your rights with respect to your information: • Access – You have the right to review and obtain a copy of your information that may be used to make decisions about you, such as claims and case or medical management records. You also may receive a summary of this health information. If you request copies, we may charge you a fee for each page, a per hour charge for staff time to locate and copy your information, and postage. • Alternate Communications – You have the right to receive confidential communications of information in a different manner or at a different place to avoid a life-threatening situation. We will accommodate your request if it is reasonable. • Amendment – You have the right to request an amendment of information we maintain about you if you believe the information is wrong or incomplete. We may deny your request if we did not create the information, we do not maintain the information, or the information is correct and complete. If we deny your request, we will give you a written explanation of the denial. • Disclosure – You have the right to receive a listing of instances in which we or our business associates have disclosed your information for purposes other than treatment, payment, health plan operations, and certain other activities. Effective April 1, 2003 or whenever you became a Humana member, Humana began maintaining these types of disclosures and will maintain this information for a period of six years. If you request this list more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests. • Notice – You have the right to receive a written copy of this notice any time you request. • Restriction – You have the right to ask to restrict uses or disclosures of your information. We are not required to agree to these restrictions, but if we do, we will abide by our agreement. You also have the right to agree to or terminate a previously submitted restriction. Notice of Privacy Practices (continued) How do I exercise my rights or obtain a copy of this notice? All of your privacy rights can be exercised by obtaining the applicable privacy rights request forms. You may obtain any of the forms by: • Contacting us at 0-000-000-0000 at any time • Accessing our Website at Xxxxxx.xxx and going to the Privacy Practices link • E-mailing us at privacy xxxxxx@xxxxxx.xxx Send completed request form to: Humana Privacy Xxxxxx X.X. Xxx 0000 XxxxxxxxxxOffice P.O. Box 1438 Louisville, XX 00000 KY 40202 What should I do if I believe my privacy has been violated? If you believe your privacy has been violated in any way, you may file a complaint with Human by calling us at: 0-000-000-0000 any time. You may also submit a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights (OCR). We will give you the appropriate OCR regional address on request. You also have the option to e-mail your complaint to XXXXxxxxxxxx@xxx.xxx. We support your right to protect the privacy of your personal and health information. We will not retaliate in any way if you elect to file a complaint with us or with the U.S. Department of Health and Human Services.