This notice is provided to you under the requirements of federal legislation entitled
the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This is a
periodic notice that you will continue to receive while you are insured with our
Company. This notice does not affect your coverage in any way.
No action is required of you.
Effective date of this notice: April 14, 2003
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.
SUMMARY
In order to provide you with benefits, we will receive personal information about
your health, from you, your physicians, hospitals, and others who provide you with
health care services. We are required to keep this information confidential. This
notice of our privacy practices is intended to inform you of the ways we may use
your information and the occasions on which we may disclose this information to
others.
Occasionally, we may use members’ information when providing treatment. We use
members’ health information to provide benefits. We disclose members’ informa-
tion to health care providers to assist them to provide you with treatment or to help
them receive payment, we may disclose information to other insurance companies
as necessary to receive payment, we may use the information within our organiza-
tion to evaluate quality and improve health care operations, and we may make
other uses and disclosures of members’ information as required by law or as per-
mitted by your policy.
KINDS OF INFORMATION THAT THIS NOTICE APPLIES TO
This notice applies to any information in our possession that would allow someone
to identify you and learn something about your health. It does not apply to infor-
mation that contains nothing that could reasonably be used to identify you.
WHO MUST ABIDE BY THIS NOTICE
• The Company.
• All employees, staff, and other personnel whose work is under the direct control
of the Company.
The people and organizations to which this notice applies