1
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.
HEALTH PLAN NOTICE OF PRIVACY PRACTICES
Notice for Medical Information: Pages 1–3.
Notice for Financial Information: Page 4.
We
1
are required by law to protect the privacy of your health
information. We are also required to provide you this notice,
which explains how we may use information about you and when
we can give out or “disclose” that information to others. You also
have rights regarding your health information that are described
in this notice. We are required by law to abide by the terms of this
notice that is currently in effect.
The terms “information” or “health information” in this notice
include information we maintain that reasonably can be used
to identify you and that relates to your physical or mental health
condition, the provision of health care to you, or the payment
for such health care. We will comply with the requirements of
applicable privacy laws related to notifying you in the event of a
breach of your health information.
We have the right to change our privacy practices and the
terms of this notice. If we make a material change to our privacy
practices, we will provide to you, in our next annual distribution,
either a revised notice or information about the material change
and how to obtain a revised notice. We will provide you with this
information either by direct mail or electronically, in accordance
with applicable law. In all cases, if we maintain a website for your
particular health plan, we will post the revised notice on your
health plan website. We reserve the right to make any revised or
changed notice effective for information we already have and for
information that we receive in the future.
How We Collect, Use, and
Disclose Information
We collect, use, and disclose your health information to provide
that information:
• To you or someone who has the legal right to act for you
(your personal representative) in order to administer your
rights as described in this notice; and
• To the Secretary of the Department of Health and Human
Services, if necessary, to confirm we are meeting our
privacy obligations.
We may collect, use, and disclose health information for your
treatment, to pay for your health care and to operate our business.
For example, we may collect, use, and disclose your health
information:
• For Payment of premiums owed to us, to determine your
health care coverage, and to process claims for health care
services you receive, including for coordination of other
benefits you may have. For example, we may tell a doctor
whether you are eligible for coverage for certain medical
procedures and what percentage of the bill may be covered.
• For Treatment, including to aid in your treatment or the
coordination of your care. For example, we may share
information with other doctors to help them provide medical
care to you.
• For Health Care Operations as necessary to operate and
manage our business activities related to providing and
managing your health care coverage. For example, we might
talk to your physician to suggest a disease management or
wellness program that could help improve your health or we
may analyze data to determine how we can improve
our services. We may also de-identify health information in
accordance with applicable laws.
• To Provide You Information on Health-Related Programs
or Products such as alternative medical treatments and
programs or about health-related products and services,
subject to limits imposed by law.
• For Plan Sponsors, if your coverage is through an employer
sponsored group health plan. We may share summary health
information and enrollment and disenrollment information
with the plan sponsor. We also may share other health
information with the plan sponsor for plan administration
purposes if the plan sponsor agrees to special restrictions
on its use and disclosure of the information in accordance
with federal law.
• For Underwriting Purposes; however, we will not use
or disclose your genetic information for such purposes. For
example, we may use some health information in risk rating
and pricing such as age and gender, as permitted by state
and federal regulations. However, we do not use race,
ethnicity, language, gender identity, or sexual orientation
information in our underwriting process, or for denial of
services, coverage, and benefits.
• For Reminders, we may collect, use, and disclose health
information to send you reminders about your benefits or
Medical Information Privacy Notice
Effective January 1, 2024
2
care, such as appointment reminders with providers who
provide medical care to you.
• For Communications to You about treatment, payment
or health care operations using telephone numbers or email
addresses you provide to us.
We may collect, use, and disclose your health information for the
following purposes under limited circumstances and subject to
certain requirements:
• As Required by Law to follow the laws that apply to us.
• To Persons Involved with Your Care or who help pay for
your care, such as a family member, when you are
incapacitated or in an emergency, or when you agree or fail
to object when given the opportunity. If you are unavailable or
unable to object, we will use our best judgment to decide
if the disclosure is in your best interest. Special rules apply
regarding when we may disclose health information about
a deceased individual to family members and others. We may
disclose health information to any persons involved, prior
to the death, in the care or payment for care of a deceased
individual, unless we are aware that doing so would be
inconsistent with a preference previously expressed by
the deceased.
• For Public Health Activities such as reporting or preventing
disease outbreaks to a public health authority. We may also
disclose your information to the Food and Drug Administration
(FDA) or persons under the jurisdiction of the FDA for
purposes related to safety or quality issues, adverse events or
to facilitate drug recalls.
• For Reporting Victims of Abuse, Neglect or Domestic
Violence to government authorities that are authorized by
law to receive such information, including a social service or
protective service agency.
• For Health Oversight Activities to a health oversight agency
for activities authorized by law, such as licensure,
governmental audits and fraud and abuse investigations.
• For Judicial or Administrative Proceedings such as in
response to a court order, search warrant or subpoena.
• For Law Enforcement Purposes to a law enforcement
official for purposes such as providing limited information to
locate a missing person or report a crime.
• To Avoid a Serious Threat to Health or Safety to you,
another person, or the public, by, for example, disclosing
information to public health agencies or law enforcement
authorities, or in the event of an emergency or natural disaster.
• For Specialized Government Functions such as military
and veteran activities, national security and intelligence
activities, and the protective services for the President
and others.
• For Workers’ Compensation as authorized by, or to the
extent necessary to comply with, state workers compensation
laws that govern job-related injuries or illness.
• For Research Purposes such as research related to the
evaluation of certain treatments or the prevention of disease
or disability, if the research study meets federal privacy law
requirements, or for certain activities related to preparing a
research study.
• To Provide Information Regarding Decedents to a coroner
or medical examiner to identify a deceased person, determine
a cause of death, or as authorized by law. We may also use
and disclose information to funeral directors as necessary to
carry out their duties.
• For Organ Donation Purposes to entities that handle
procurement, banking or transplantation of organs, eyes or
tissue to facilitate donation and transplantation.
• To Correctional Institutions or Law Enforcement Officials
if you are an inmate of a correctional institution or under the
custody of a law enforcement official, but only if necessary
(1) for the institution to provide you with health care; (2) to
protect your health and safety or the health and safety of
others; or (3) for the safety and security of the correctional
institution.
• To Business Associates that perform functions on our
behalf or provide us with services if the information is
necessary for such functions or services. Our business
associates are required, under contract with us and pursuant
to federal law, to protect the privacy of your information.
• Additional Restrictions on Use and Disclosure. Some
federal and state laws may require special privacy protections
that restrict the use and disclosure of certain sensitive
health information. Such laws may protect the following types
of information:
1. Alcohol and Substance Use Disorder
2. Biometric Information
3. Child or Adult Abuse or Neglect, including
Sexual Assault
4. Communicable Diseases
5. Genetic Information
6. HIV/AIDS
7. Mental Health
8. Minors’ Information
9. Prescriptions
10. Reproductive Health
11. Sexually Transmitted Diseases
We will follow the more stringent and protective law, where it
applies to us.
Except for uses and disclosures described in this notice,
we will use and disclose your health information only with
a written authorization from you. This includes, except for
limited circumstances allowed by federal privacy law, not using
or disclosing psychotherapy notes about you, selling your
health information to others, or using or disclosing your health
information for certain marketing communications, without your
written authorization. Once you give us authorization to use or
disclose your health information, you may take back or “revoke”
your written authorization at any time in writing, except if we have
already acted based on your authorization. For information on
3
how to revoke your authorization, contact the phone number
listed on your health plan ID card.
What Are Your Rights
The following are your rights with respect to your health
information:
• You have the right to ask to restrict our uses or disclosures
of your information for treatment, payment, or health care
operations. You also have the right to ask to restrict
disclosures of your information to family members or to
others who are involved in your health care or payment
for your health care. We may also have policies on dependent
access that authorize your dependents to request certain
restrictions. Any request for restrictions must be made in
writing. Please note that while we will try to honor your
request and will permit requests consistent with our
policies, we are not required to agree to any request for
a restriction.
• You have the right to ask to receive confidential
communications of information in a different manner or
at a different place (for example, by sending information to a
P.O. Box instead of your home address). We will
accommodate reasonable requests in accordance with
applicable state and federal law. In certain circumstances,
we will accept your verbal request to receive confidential
communications, however; we may also require you to
confirm your request in writing. In addition, any requests to
modify or cancel a previous confidential communication
request must be made in writing. Mail your request to the
address listed below.
• You have the right to request to see and obtain a copy of
certain health information we maintain about you such
as claims and case or medical management records. If we
maintain your health information electronically, you have the
right to request that we send a copy of your health information
in an electronic format to you. In some cases, you may
receive a summary of this health information. You must make
a written request to inspect and copy your health information.
Mail your request to the address listed below. In certain
limited circumstances, we may deny your request to inspect
and copy your health information. If we deny your request,
you may have the right to have the denial reviewed. We may
charge a reasonable fee for any copies.
• You have the right to ask to amend certain health
information we maintain about you such as claims and
case or medical management records, if you believe the
health information about you is wrong or incomplete. Your
request must be in writing and provide the reasons for the
requested amendment. Mail your request to the address listed
below. We will respond to your request in the timeframe
required under applicable law. In certain circumstances, we
may deny your request. If we deny your request, you may
have a statement of your disagreement added to your
health information.
• You have the right to request an accounting of certain
disclosures of your information made by us during the six
years prior to your request. This accounting will not include
disclosures of information made: (i) for treatment, payment,
and health care operations purposes; (ii) to you or pursuant
to your authorization; (iii) to correctional institutions or law
enforcement officials; and (iv) other disclosures for which
federal law does not require us to provide an accounting. Any
request for an accounting must be made in writing.
• You have the right to a paper copy of this notice. You may
ask for a copy of this notice at any time. Even if you have
agreed to receive this notice electronically, you are still entitled
to a paper copy of this notice. If we maintain a website, we will
post a copy of the revised notice on our website. You may
also obtain a copy of this notice on your website.
• In certain states, you may have the right to request
that we delete your personal information. Depending
on your state of residence, you may have the right to request
deletion of your personal information. We will respond to your
request in the timeframe required under applicable law. If
we are unable to honor your request, we will notify you of our
decision. If we deny your request, you have the right to submit
to us a written statement of the reasons for your disagreement
with our assessment of the disputed information and what
you consider to be the correct information. We will make
your statement accessible to parties reviewing the information
in dispute.
Exercising Your Rights
• Contacting your Health Plan. If you have any questions
about this notice or want information about how to exercise
your rights, please call the toll-free member phone
number on your health plan ID card or you may contact
a UnitedHealth Group Customer Call Center
Representative at 1-866-633-2446 (TTY/RTT 711).
• Submitting a Written Request. To exercise any of your rights
described above, mail your written requests to us at the
following address:
UnitedHealthcare
Customer Service - Privacy Unit
PO Box 740815
Atlanta, GA 30374-0815
• Filing a Complaint. If you believe your privacy rights have
been violated, you may file a complaint with us at the address
listed above.
You may also notify the Secretary of the U.S. Department of
Health and Human Services of your complaint. We will not
take any action against you for filing a complaint.
1
This Medical Information Notice of Privacy Practices applies to health plans that are
affiliated with UnitedHealth Group. For a current list of health plans subject to this
notice go to www.uhc.com/privacy/entities-fn-v1.
4
2
For purposes of this Financial Information Privacy Notice, “we” or “us” refers to health plans affiliated with UnitedHealth Group, and the following UnitedHealthcare affiliates:
ACN Group of California, Inc.; AmeriChoice Corporation; Benefitter Insurance Solutions, Inc.; Claims Management Systems, Inc.; Dental Benefit Providers, Inc.; Ear Professional
International Corporation; Excelsior Insurance Brokerage, Inc.; gethealthinsurance.com Agency, Inc.; Golden Outlook, Inc.; Golden Rule Insurance Company; HealthMarkets
Insurance Agency; Healthplex of CT, Inc.; Healthplex of NJ, Inc.; Healthplex, Inc.; HealthSCOPE Benefits, Inc.; International Healthcare Services, Inc.; Level2 Health IPA, LLC;
Level2 Health Holdings, Inc.; Level2 Health Management, LLC; Managed Physical Network, Inc.; Optum Care Networks, Inc; OptumHealth Care Solutions, LLC; Optum Health
Networks, Inc.; Oxford Benefit Management, Inc.; Oxford Health Plans LLC; Physician Alliance of the Rockies, LLC; POMCO Network, Inc.; POMCO, Inc.; Real Appeal, LLC;
Solstice Administrators of Alabama, Inc.; Solstice Administrators of Missouri, Inc.; Solstice Administrators of North Carolina, Inc.; Solstice Administrators, Inc.; Solstice Benefit
Services, Inc.; Solstice of Minnesota, Inc.; Solstice of New York, Inc.; Spectera, Inc.; Three Rivers Holding, Inc.; UHIC Holdings, Inc.; UMR, Inc.; United Behavioral Health;
United Behavioral Health of New York I.P.A., Inc.; UnitedHealthcare, Inc.; United HealthCare Services, Inc.; UnitedHealth Advisors, LLC; UnitedHealthcare Service LLC; Urgent
Care MSO, LLC; USHEALTH Administrators, LLC; USHEALTH Group, Inc.; and Vivify Health, Inc. This Financial Information Privacy Notice only applies where required by law.
Specifically, it does not apply to (1) health care insurance products offered in Nevada by Health Plan of Nevada, Inc. and Sierra Health and Life Insurance Company, Inc.; or (2)
other UnitedHealth Group health plans in states that provide exceptions for HIPAA covered entities or health insurance products. For a current list of entities subject to this notice
go to www.uhc.com/privacy/entities-fn-v1
THIS NOTICE DESCRIBES HOW FINANCIAL INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED. PLEASE REVIEW IT CAREFULLY.
Financial Information Privacy Notice
Effective January 1, 2024
We
2
are committed to maintaining the confidentiality of your
personal financial information. For the purposes of this notice,
“personal financial information” means information about an
enrollee or an applicant for health care coverage that identifies
the individual, is not generally publicly available, and is collected
from the individual or is obtained in connection with providing
health care coverage to the individual.
Information We Collect
Depending upon the product or service you have with us, we
may collect personal financial information about you from the
following sources:
• Information we receive from you on applications or other
forms, such as name, address, age, medical information and
Social Security number;
• Information about your transactions with us, our affiliates or
others, such as premium payment and claims history; and
• Information from a consumer reporting agency.
Disclosure of Information
We do not disclose personal financial information about our
enrollees or former enrollees to any third party, except as required
or permitted by law. For example, in the course of our general
business practices, we may, as permitted by law, disclose any
of the personal financial information that we collect about you,
without your authorization, to the following types of institutions:
• To our corporate affiliates, which include financial service
providers, such as other insurers, and non-financial
companies, such as data processors;
• To nonaffiliated companies for our everyday business
purposes, such as to process your transactions, maintain your
account(s), or respond to court orders and legal
investigations; and
• To nonaffiliated companies that perform services for us,
including sending promotional communications on
our behalf.
Confidentiality and Security
We maintain physical, electronic and procedural safeguards,
in accordance with applicable state and federal standards, to
protect your personal financial information against risks such as
loss, destruction or misuse. These measures include computer
safeguards, secured files and buildings, and restrictions on who
may access your personal financial information.
Questions About this Notice
If you have any questions about this notice, please call the toll-
free member phone number on your health plan ID card or
contact the UnitedHealth Group Customer Call Center at
1-866-633-2446 (TTY 711).
5
Language Assistance Services
We
1
provide free language services to help you communicate with us. We offer interpreters, letters in other languages, and letters in other
formats like large print. To get help, please call 1-866-633-2446 or the toll-free member phone number listed on your health plan ID card
TTY/RTT 711. We are available Monday through Friday, 8 a.m. to 8 p.m. E.T.
9
Language Assistance Services
We
1
provide free language services to help you communicate with us. We offer
interpreters, letters in other languages, and letters in other formats like large print. To
get help, please call 1-866-633-2446 or the toll-free member phone number listed on
your health plan ID card TTY/RTT 711. We are available Monday through Friday, 8 a.m.
to 8 p.m. E.T.
ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin
cargo, a su disposición. Llame al 1-866-633-2446.
請注意：如果您說中文 (Chinese)，我們免費為您提供語言協助服務。請致電：1-866-
633-2446。
XIN LƯU Ý: Nếu quý vị nói tiếng Việt (Vietnamese), quý vị sẽ được cung cấp dịch vụ
trợ giúp về ngôn ngữ miễn phí. Vui lòng gọi 1-866-633-2446.
알림:
한
한
국
국
어
어
(Korean)를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수
있습니다. 1-866-633-2446번으로 전화하십시오.
PAUNAWA: Kung nagsasalita ka ng Tagalog (Tagalog), may makukuha kang mga
libreng serbisyo ng tulong sa wika. Mangyaring tumawag sa 1-866-633-2446.
ВНИМАНИЕ: бесплатные услуги перевода доступны для людей, чей родной язык
является Русский (Russian). Позвоните по номеру 1-866-633-2446.
ﺗﻧﺑﯾﮫ: إذا ﻛﻧت ﺗﺗﺣدث ا ﻟ ﻌرﺑ ﯾﺔ )Arabic(، ﻓﺈن ﺧدﻣﺎت اﻟﻣﺳﺎﻋدة اﻟﻠﻐوﯾﺔ اﻟﻣﺟﺎﻧﯾﺔ ﻣﺗﺎﺣﺔ ﻟك. اﻟرﺟﺎء اﻷﺗﺻﺎل ﺑـ
1-866-633-2446.
ATANSYON: Si w pale Kreyòl ayisyen (Haitian Creole), ou kapab benefisye sèvis ki
gratis pou ede w nan lang pa w. Tanpri rele nan 1-866-633-2446.
ATTENTION : Si vous parlez français (French), des services d’aide linguistique vous
sont proposés gratuitement. Veuillez appeler le 1-866-633-2446.
UWAGA: Jeżeli mówisz po polsku (Polish), udostępniliśmy darmowe usługi tłumacza.
Prosimy zadzwonić pod numer 1-866-633-2446.
ATENÇÃO: Se você fala português (Portuguese), contate o serviço de assistência de
idiomas gratuito. Ligue para 1-866-633-2446.
ATTENZIONE: in caso la lingua parlata sia l’italiano (Italian), sono disponibili servizi di
assistenza linguistica gratuiti. Si prega di chiamare il numero 1-866-633-2446.
6
10
ACHTUNG: Falls Sie Deutsch (German) sprechen, stehen Ihnen kostenlos sprachliche
Hilfsdienstleistungen zur Verfügung. Rufen Sie 1-866-633-2446 an.
注意事項：
日日本本語語
(Japanese)
を話される場合、無料の言語支援サービスをご利用いただけ
ます。1-866-633-2446 にお電話ください。
ﺗوﺟﮫ: ا ﮔر زﺑ ﺎن ﺷﻣ ﺎ ﻓ ﺎ رﺳﯽ )Farsi( اﺳت، ﺧدﻣ ﺎت ا ﻣد ا د زﺑ ﺎ ﻧﯽ ﺑ ﮫ طور را ﯾﮕﺎن در اﺧﺗ ﯾ ﺎر ﺷﻣ ﺎ ﻣﯽ ﺑ ﺎﺷد .
1-866-633-2446ﺗﻣﺎس ﺑﮕﯾرﯾ د.
क
ृ
पा %यान द
)
: य*द आप !हंद% (Hindi) भाषी ह
0
तो आपके 4लए भाषा सहायता सेवाएं :न:श
ु
=क उपल?ध
ह
0
। क
ृ
पा पर काल कर
)
1-866-633-2446.
CEEB TOOM: Yog koj hais Lus Hmoob (Hmong), muaj kev pab txhais lus pub dawb
rau koj. Thov hu rau 1-866-633-2446.
ចំ#ប់&រម)ណ៍ៈ
េប#សិនអ(កនិ*យ!"ែខ%រ(Khmer)េស,ជំនួយ01េ2យឥតគិតៃថ8 គឺ:នសំ;ប់អ(ក។
សូ មទ
ូ
រស័ពD េEេលខ
1-866-633-2446។
PAKDAAR: Nu saritaem ti Ilocano (Ilocano), ti serbisyo para ti baddang ti lengguahe
nga awanan bayadna, ket sidadaan para kenyam. Maidawat nga awagan iti 1-866-633-
2446.
DÍÍ BAA'ÁKONÍNÍZIN: Diné (Navajo) bizaad bee yániłti'go, saad bee áka'anída'awo'ígíí,
t'áá jíík'eh, bee ná'ahóót'i'. T'áá shoodí kohjį' 1-866-633-2446 hodíilnih.
OGOW: Haddii aad ku hadasho Soomaali (Somali), adeegyada taageerada luqadda,
oo bilaash ah, ayaad heli kartaa. Fadlan wac 1-866-633-2446.
ΠΡΟΣΟΧΗ : Αν μιλάτε Ελληνικά (Greek), υπάρχει δωρεάν βοήθεια
στη γλώσσα σας. Παρακαλείστε να καλέσετε 1-866-633-2446.
!યાન આપો: જો તમે !
ુ
જરાતી (Gujarati) બોલતા હો તો આપને ભાષાક2ય મદદ4પ સેવા
િવના 8
ૂ
:યે ;ા<ય છે.
!
ૃ
પા કર'1-866-633-2446 પર કોલ કરો.
УВАГА: Якщо ви розмовляєте українською мовою (Ukrainian), у вас є можливість
скористатися безкоштовними послугами перекладача.
Зателефонуйте, будь ласка, за номером 1-866-633-2446.
7
Notice of Non-Discrimination
We
3
do not treat members differently because of sex, age, race, color, disability or national origin.
If you think you were treated unfairly because of your sex, age, race, color, disability or national origin, you can send a complaint to:
Civil Rights Coordinator
UnitedHealthcare Civil Rights Grievance
P.O. Box 30608
Salt Lake City, UTAH 84130
You must send the complaint within 60 days of the incident. We will send you a decision within 30 days. If you disagree with the decision,
you have 15 days to appeal.
If you need help with your complaint, please call 1-866-633-2446 or the toll-free member phone number listed on your health plan ID
card, TTY/RTT 711. We are available Monday through Friday, 8 a.m. to 8 p.m. E.T.
You can also file a complaint with the U.S. Dept. of Health and Human services.
Online: https://ocrportal.hhs.gov/ocr/portal/lobby.jsf
Complaint forms are available at https://www.hhs.gov/ocr/complaints/index.html
Phone: Toll-free 1-800-368-1019, 1-800-537-7697 (TDD)
Mail: U.S. Dept. of Health and Human Services. 200 Independence Avenue,
SW Room 509F, HHH Building Washington, D.C. 20201
3
For purposes of the Language Assistance Services and this Non-Discrimination Notice (“Notice”), “We” refers to the entities listed in Footnote 1 of the Notice of Privacy Practices
and Footnote 2 of the Financial Information Privacy Notice. Please note that not all entities listed are covered by this Notice.
EI20464455.3 3/24 © 2024 United HealthCare Services, Inc. All Rights Reserved.
