Form 34.417
3/03
ENTITIES COVERED BY THIS NOTICE:
BCS Life Insurance Company
BCS Insurance Company
The above are entities covered by this notice in so far as they provide or pay the cost of medical care as defined by the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) and its attendant regulations.
Privacy Practices Notice
REVIEW THIS NOTICE CAREFULLY
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
Our Legal Duty
We are required by applicable federal and state law to maintain the privacy of your medical information. We are also required to give you this
notice about our privacy practices, our legal duties, and your rights concerning your medical information. We must follow the privacy practices
that are described in this notice while it is in effect. This notice takes effect April 14, 2003, and will remain in effect until we replace it.
We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by
applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all medical
information that we maintain, including medical information we created or received before we made the changes. Before we make a
significant change in our privacy practices, we will change this notice and send the new notice available to our health plan subscribers at the
time of the change.
You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice,
please contact us using the information listed at the end of this notice.
Uses and Disclosures of Medical Information
We use and disclose medical information about you for treatment, payment, and health care operations. For example:
Treatment: We may use or disclose your medical information to a physician or other health care provider in order to provide treatment to you.
Payment: We m