NOTICE OF PRIVACY POLICY AND PRACTICES

THIS NOTICE DESCRIBES HOW PERSONAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCOLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

PURPOSE

KBBG respects the privacy of personal information and understands the importance of keeping this information confidential and secure. This Notice describes KBBG’s policies and practices for collecting, handling and protecting Personal Health Information of our members. From time to time, it may be necessary to revise our privacy policy in the future. Should such a change be required, we will notify you in writing in advance of the change.

PERSONAL HEALTH INFORMATION

As a member of a benefit program administered by KBBG, your healthcare information, including, but not limited to, name, address, social security number, member identification number, medical records, billing records, claims information, medical conditions, prescribed medications, and precertification information (“Personal Health Information”), need to be collected, maintained and made available to KBBG employees and strategic partners so that KBBG can administer its program on your behalf.

You have the right to: (i) request certain restrictions on the use of your Personal Health Information; (ii) receive an accounting of disclosures of use of your Personal Health Information; (iii) amend your Personal Health Information; (iv) complain to KBBG’s Human Services if you believe your privacy rights have been violated; and (v) revoke your authorization to KBBG to use and disseminate you Personal Health Information.

DISCLOSURE

• We will use and disclose Personal Health Information as necessary to administer benefit programs or assist in claims adjustment.
• We may disclose Personal Health Information with contracted service providers.
• We may disclose Personal Health Information as permitted by law with our attorneys, accountants and auditors, your authorized representative, healthcare providers, third party administrators or insurance companies.
• We may disclose your Personal Health Information under order of a court of law in connection with a legal proceeding.
• We may disclose your Personal Health Information to government agencies or accrediting organizations that monitor our compliance with applicable laws and standards.
• We may disclose your Personal Health Information under a subpoena or summons to government agencies that investigate fraud or other violations of law.
• We do not disclose your Personal Health Information to any other third parties without a member’s request or authorization.

DISCLAIMER

KBBG does not provide health insurance or medical services, nor does it recommend treatment. KBBG provides administrative and informational services through our employees and contracted service providers. All of KBBG’s services are offered in a manner that fully respects and protects the privacy of our members and the confidentiality of their medical information.

Effective: April, 2003

Karr Barth Benefits Group, Inc. Privacy Notice