As a Member of the Plan, you have the following rights regarding your PHI:

• Right to Inspect and Copy: With limited exceptions, you have the right to inspect and/or obtain a copy of your PHI that the Plan maintains in a designated record set. A “designated record set” consists of all documentation relating to your enrollment and the Plan’s use of your PHI including, for example, payment, claims adjudication and case or medical management. You may request that we provide copies of your PHI to you in a format other than photocopies, which we will use unless we cannot practicably do so. You must make a request in writing to obtain access to your PHI.

The Plan may charge you a reasonable cost-based fee to process and fulfill your request. If you prefer, you may request that we prepare a summary or an explanation of your PHI for a fee. Contact us using the information listed at the end of this notice for a full explanation of our fee structure. If your request for access is denied, we will provide a written explanation for the denial and your rights regarding the denial.

The Plan does not receive or maintain a file of your treatment records. You have a right to access these records through the treating physician, facility, or other provider that created and/or maintains the records.

• Right to Amend: You have the right to request that the Plan amend the PHI that we have created and that is maintained in our designated record set. Your request must be in writing, and it must explain why the information should be amended.

The Plan cannot amend demographic information, treatment records or any other information created by others. If you would like to amend any of this information, please contact your personnel office or, to amend your treatment records, you must contact the treating physician, facility or other provider that created these records.

We may deny your request if: 1) we did not create the information; 2) the information is not part of the designated record set maintained by the Plan; 3) you do not have access rights to the information; or 4) we believe the information is accurate and complete.

• Right to an Accounting of Disclosures: You have the right to receive an accounting of the instances in which the Plan or our Business Associates have disclosed your PHI. You may request an accounting of disclosures made over the past six years or back to April 14, 2004, whichever period is shorter. Your request for an accounting must be made in writing.

We do not have to provide you with an accounting of certain excepted disclosures, such as those made for treatment, payment or health care operations purposes or made in accordance with an authorization, so these will not appear on the accounting.

• Right to Request Restrictions: You have the right to request that the Plan place additional restrictions on the use or disclosure of your PHI for treatment, payment, health care operations purposes, and for disclosures made to persons involved in your care. Your request for restrictions must be in writing.

We are not required to agree to these additional restrictions and in some cases will be prohibited from agreeing to them, but if we do agree, we will abide by our agreement (except in an emergency). Generally, the Plan will not agree to requests for restrictions on uses and disclosures of PHI for treatment, payment or health care operations. It is necessary for us to use and disclose PHI for these purposes in order to provide the benefits that are afforded to you. If we do agree to a restriction, our agreement will always be in writing and signed by the Privacy Officer.

• Right to Request Confidential Communications: You have the right to request that we communicate with you in confidence about your PHI by using “alternative means” or an “alternative location” if the disclosure of all or part of that information to another person could endanger you. We will accommodate such a request if it is reasonable, if the request specifies the alternative means or locations, and if it continues to permit the Plan to collect premiums and pay its claims. To request confidential communication changes, you must make your request in writing, and you must clearly state that the information could endanger you if it is not communicated in confidence as you request.

Right to Receive a Paper Copy of the Notice

If you receive this notice from our website or by e-mail, you are entitled to receive this notice in writing. Please contact us using the Questions and Complaints Link to obtain this notice in written form.