Notice of Privacy Practices for PacifiCare

Effective April 14, 2003

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. NO ACTION IS REQUIRED ON YOUR PART.

At PacifiCare the protection of our members' privacy and the confidentiality of medical information has always been a priority. We recognize that you depend upon us to safeguard your personal information and uphold your privacy rights. This document — which is based on state and federal law, as well as our own company code of ethics — offers a declaration of our commitment to preserving member confidentiality and privacy.

Our Privacy Practices

This notice describes PacifiCare’s privacy practices for both current and former members. It explains how we use health information about you and when we may share that health information with others. It also informs you about your rights with respect to your health information and how you may exercise these rights. We are required by law to maintain the privacy of your health information and to send you a copy of this notice so that you are aware of how we maintain the privacy of your health information.

PacifiCare employees are required to comply with our policies and procedures to protect the confidentiality of health information. Any employee who violates our privacy policy is subject to a disciplinary process. Employee access to health information is limited on a business “need-to-know” basis, such as: to make benefit determinations, pay claims, manage care, underwrite coverage, perform quality assessment measurements, administer a plan or provide customer service.

PacifiCare maintains physical, electronic and process safeguards that restrict unauthorized access to your health information. Such safeguards include secured office facilities, locked file cabinets, and controlled computer network systems and password accounts.

This notice applies to all applicable companies within the PacifiCare family of companies, which includes businesses owned or controlled by PacifiCare Health Systems, Inc. (PacifiCare).

Please share this notice with everyone covered by your policy or contract. You have a right to receive a copy of this notice upon request at any time. If you would like additional copies of the notice or have questions related to the information contained within the notice, please call Member/Customer Services at the toll-free number on your health plan identification card. You may also view a copy of this notice on our Web sites at www.pacificare.com and www.securehorizons.com.

Should any of our privacy practices change, we reserve the right to change the terms of this notice and to make the new notice effective for all health information that we maintain. We will provide you a copy of the revised notice and post the revised notice on our Web sites.

Health Care Information Maintained At PacifiCare

When we refer to "information" or "health information" in this notice, we mean information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health and related health care services. Health information may be transmitted or shared in any form or medium (oral, written or electronic).

The health information we receive may vary by product; therefore, the examples that follow may not apply to all members, but are designed to represent the general categories of information that may be received and maintained by PacifiCare:

• Information provided by you on applications, forms, surveys and our Web sites, such as your name, address and date of birth;
• Information from physicians, hospitals or other health care providers, clinics, medical groups, or health care service plans;
• Information provided by your employer, benefits plan sponsor or association, regarding any group product that you may have;
• Information about your transactions and experiences with our affiliates, others and us, such as products or services purchased, account balances, payment history, claims history, policy coverage and premiums;
• Information from consumer or medical reporting agencies or other third parties, including medical and demographic information.

How We May User Or Share Your Information

The following categories describe how we may use and share your health information. For each category we provide examples that help illustrate each type of use or disclosure. Not every use or disclosure in a category will be listed. However, the ways in which we are permitted to use and share health information will fall into one of these categories.

For Treatment
We may share health information with your doctors or hospitals to help them provide medical care for you. For example, if you are hospitalized, we may allow the hospital staff access to any medical records sent to us by your doctor.

We may also use or share your health information with others to help coordinate and manage.