Notice of privacy practices

• This notice combines three required yearly communications Legal Rights & Agreement Rules

Important information about your rights and our responsibilities

Your protected health information

Protecting your personal health information is important. Each year, we’re required to send you specific information about your rights and some of our duties to help keep your information safe. This notice combines three of these required yearly communications:

• This notice combines three required yearly communications Legal Rights & Agreement Rules

• State notice of privacy practices
• • This notice combines three required yearly communications Legal Rights & Agreement Rules
• Health Insurance Portability and Accountability Act (HIPAA) notice of privacy practices
• • This notice combines three required yearly communications Legal Rights & Agreement Rules
• Breast reconstruction surgery benefits
• • This notice combines three required yearly communications Legal Rights & Agreement Rules

Would you like to go paperless and read this online or on our mobile app next time? Go to anthem.com and sign up to get these notices by email.

• Members can sign up to get these notices by email Account & Service Control

State notice of privacy practices

• Anthem follows state law, which is sometimes stricter than HIPAA Legal Rights & Agreement Rules

When it comes to handling your health information, we follow relevant state laws, which are sometimes stricter than the federal HIPAA privacy law. This notice:

• Anthem follows state law, which is sometimes stricter than HIPAA Legal Rights & Agreement Rules

• Explains your rights and our duties under state law.
• • Anthem follows state law, which is sometimes stricter than HIPAA Legal Rights & Agreement Rules
• Applies to health, dental, vision, and life insurance benefits you may have.
• • Anthem follows state law, which is sometimes stricter than HIPAA Legal Rights & Agreement Rules

Your state may give you additional rights to limit sharing your health information. Please call the Member Services phone number on your health plan ID card for more details.

• A member's state may give additional rights to limit sharing Sharing & Disclosure

Your personal information

• Personal information (PI) is nonpublic information that identifies you Data Access & Collection

Your nonpublic (private) personal information (PI) identifies you and it’s often gathered in an insurance matter. You have the right to see and correct your PI. We may collect, use, and share your PI as described in this notice. Our goal is to protect your PI because your information can be used to make judgments about your health, finances, character, habits, hobbies, reputation, career, and credit.

• Personal information (PI) is nonpublic information that identifies you Data Access & Collection
• Members have the right to see and correct their PI Account & Service Control

We may receive your PI from others, such as doctors, hospitals, or other insurance companies. We may also share your PI with others outside our company — without your approval, in some cases. But we take reasonable measures to protect your information. If an activity requires us to give you a chance to opt out, we’ll let you know, and we’ll let you know how to tell us you don’t want your PI used or shared for an activity you can opt out of.

• Anthem may receive PI from doctors, hospitals or other insurers Data Access & Collection
• Anthem may share PI outside the company, in some cases without approval Sharing & Disclosure
• Where an activity requires an opt-out chance, Anthem says it will tell members how Sharing & Disclosure

THIS NOTICE DESCRIBES HOW MEDICAL, VISION, AND DENTAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ AND REVIEW CAREFULLY.

• The HIPAA notice describes use, disclosure and access for medical, vision and dental information Legal Rights & Agreement Rules

HIPAA notice of privacy practices

• Anthem keeps current and former members' information private as required Legal Rights & Agreement Rules

We keep the health and financial information of our current and former members private as required by law, accreditation standards, and our own internal rules. We’re also required by federal law to give you this notice to explain your rights and our legal duties and privacy practices.

• Anthem keeps current and former members' information private as required Legal Rights & Agreement Rules

Your protected health information

• Anthem may collect, use and share PHI as the law allows or requires Use & Processing

There are times we may collect, use, and share your Protected Health Information (PHI) as allowed or required by law, including the HIPAA Privacy rule. Here are some of those times:

• Anthem may collect, use and share PHI as the law allows or requires Use & Processing

Payment: We collect, use, and share PHI to take care of your account and benefits or to pay claims for healthcare you get through your plan.

• PHI is used and shared to manage accounts and benefits and pay claims Use & Processing

Healthcare operations: We collect, use, and share PHI for our healthcare operations.

• PHI is used and shared for Anthem's healthcare operations Use & Processing

Treatment activities: We don’t provide treatment, but we collect, use, and share information about your treatment to offer services that may help you, including sharing information with others providing you treatment.

• Anthem does not provide treatment but uses and shares treatment information to offer services Use & Processing

Examples of ways we use your information:

• Example: Anthem keeps premium and deductible payment information on file Data Access & Collection

• We keep information on file about your premium and deductible payments.
• • Example: Anthem keeps premium and deductible payment information on file Data Access & Collection
• We may give information to a doctor’s office to confirm your benefits.
• • Example: Anthem may give information to a doctor's office to confirm benefits Sharing & Disclosure
• We may share your explanation of benefits (EOB) with the subscriber of your plan for payment purposes.
• • Example: Anthem may share a member's explanation of benefits with the plan subscriber Sharing & Disclosure
• We may share PHI with your doctor or hospital so that they may treat you.
• • Example: Anthem may share PHI with a doctor or hospital so they can treat the member Sharing & Disclosure
• We may use PHI to review the quality of care and services you get.
• • Example: Anthem may use PHI to review the quality of care and services Use & Processing
• We may use PHI to help you with services for conditions like asthma, diabetes, or traumatic injury.
• • Example: Anthem may use PHI to help with services for conditions like asthma, diabetes or traumatic injury Use & Processing
• We may collect and use publicly and/or commercially available data about you to support you and help you get health plan benefits and services.
• • Example: Anthem may collect and use public and commercially available data about members Data Access & Collection
• We may use PHI with technology to support and enable services provided to you.
• • Example: Anthem may use PHI with technology to support and enable services Use & Processing
• We may use your PHI to create, use, or share de-identified data as allowed by HIPAA.
• • Example: Anthem may use PHI to create, use or share de-identified data as HIPAA allows Use & Processing
• We may also use and share PHI directly or indirectly with health information exchanges for payment, healthcare operations, and treatment. If you don’t want your PHI to be shared in these situations, visit anthem.com/privacy for more information.
• • Example: Anthem may share PHI with health information exchanges Sharing & Disclosure

Sharing your PHI with you: We must give you access to your own PHI. We may also contact you about treatment options or other health-related benefits and services. When you or your dependents reach a certain age, we may tell you about other plans or programs for which you may be eligible, including individual coverage. We may also send you reminders about routine medical checkups and tests. You may get emails that have limited PHI, such as welcome materials. We’ll ask your permission before we contact you.

• Anthem must give members access to their own PHI Account & Service Control
• Anthem may contact members about treatment options, benefits and other plans Use & Processing
• Emails may carry limited PHI and Anthem says it will ask permission before contacting Sharing & Disclosure

Your protected health information

(continued)

Sharing your PHI with others: In most cases, if we use or share your PHI outside of treatment, payment, operations, or research activities, we have to get your okay in writing first. We must also get your written permission before:

• Outside treatment, payment, operations or research, Anthem generally needs written permission Sharing & Disclosure
• Written permission is required before certain marketing, selling PHI or sharing psychotherapy notes Sharing & Disclosure

• Using your PHI for certain marketing activities.
• • Written permission is required before certain marketing, selling PHI or sharing psychotherapy notes Sharing & Disclosure
• Selling your PHI.
• • Written permission is required before certain marketing, selling PHI or sharing psychotherapy notes Sharing & Disclosure
• Sharing any psychotherapy notes from your doctor or therapist
• • Written permission is required before certain marketing, selling PHI or sharing psychotherapy notes Sharing & Disclosure

We may also need your written permission for other situations not mentioned above. You always have the right to cancel any written permission you give at any time.

• Other situations may need written permission, and a member can cancel written permission at any time Sharing & Disclosure

You have the right and choice to tell us to:

• Members can tell Anthem to share information with family, friends or others involved in care or payment Sharing & Disclosure
• Members can tell Anthem to share information in an emergency or disaster relief situation Sharing & Disclosure

• Share information with your family, close friends, or others involved with your current treatment or payment for your care.
• • Members can tell Anthem to share information with family, friends or others involved in care or payment Sharing & Disclosure
• Share information in an emergency or disaster relief situation.
• • Members can tell Anthem to share information in an emergency or disaster relief situation Sharing & Disclosure

If you can’t tell us your preference, for example in an emergency or if you’re unconscious, we may share your PHI if we believe it’s in your best interest. We may also share your information when needed to lessen a serious and likely threat to your health or safety.

• If a member can't state a preference, Anthem may share PHI it believes is in their best interest Sharing & Disclosure

Other reasons we may use or share your information:

• Anthem is allowed, and sometimes required, to share information for specific public-good purposes Sharing & Disclosure

We are allowed, and in some cases required, to share your information in other ways — usually for the good of the public, such as public health and research. We can share your information for these specific purposes:

• Anthem is allowed, and sometimes required, to share information for specific public-good purposes Sharing & Disclosure

• Helping with public health and safety issues, such as:
• • Information may be shared to help with public health and safety issues Sharing & Disclosure

– Preventing disease

• Information may be shared to help with public health and safety issues Sharing & Disclosure

– Helping with product recalls

• Information may be shared to help with public health and safety issues Sharing & Disclosure

– Reporting adverse reactions to medicines

• Information may be shared to help with public health and safety issues Sharing & Disclosure

– Reporting suspected abuse, neglect, or domestic violence

• Information may be shared to help with public health and safety issues Sharing & Disclosure

– Preventing or reducing a serious threat to anyone’s health or safety

• Information may be shared to help with public health and safety issues Sharing & Disclosure

• Doing health research.
• • Information may be shared for health research Sharing & Disclosure
• Obeying the law, if it requires sharing your information.
• • Information may be shared if the law requires it Sharing & Disclosure
• Responding to organ donation groups for research and other reasons.
• • Information may be shared with organ donation groups Sharing & Disclosure
• Addressing workers’ compensation, law enforcement, and other government requests, and to alert proper authorities if we believe you may be a victim of abuse or other crimes.
• • Information may be shared for workers' compensation, law enforcement and other government requests Sharing & Disclosure
• Responding to lawsuits and legal actions.
• • Information may be shared in responding to lawsuits and legal actions Sharing & Disclosure
• Responding to the Secretary of Health and Human Services for HIPAA rules compliance and enforcement purposes.
• • Information may be shared with the Secretary of Health and Human Services for HIPAA compliance Sharing & Disclosure

If you’re enrolled with us through an employer, we may share your PHI with your group health plan. If the employer pays your premium or part of it, but doesn’t pay your health insurance claims, your employer can only have your PHI for permitted reasons and is required by law to protect it.

• Employer-based members: PHI may be shared with the group health plan; an employer may get PHI only for permitted reasons Sharing & Disclosure

Your protected health information

(continued)

Authorization: We’ll get your written permission before we use or share your PHI for any purpose not stated in this notice. You may cancel your permission at any time, in writing. We will then stop using your PHI for that purpose. But if we’ve already used or shared your PHI with your permission, we cannot undo any actions we took before you told us to stop.

• Anthem gets written permission for any purpose not stated; permission can be cancelled in writing but not undone Sharing & Disclosure

Genetic information: We cannot use your genetic information to decide whether we’ll give you coverage or how we determine the price of that coverage.

• Anthem cannot use genetic information to decide coverage or its price Use & Processing

Race, ethnicity, language, sexual orientation, and gender identity: We may collect, infer, receive and/ or maintain race, ethnicity, language, sexual orientation, and gender identity information about you and protect this information as described in this notice. We may use this information to help you, including identifying your specific needs, developing programs and educational materials, and offering interpretation services. We don’t use race, ethnicity, language, sexual orientation, and gender identity information to decide whether we’ll give you coverage, what kind of coverage and the price of that coverage. We don’t share this information with unauthorized persons.

• Anthem may collect, infer, receive or maintain race, language, sexual orientation and gender identity data Data Access & Collection
• Anthem may use this demographic information to identify needs, develop programs and offer interpretation Use & Processing
• Anthem does not use this demographic information to decide coverage, kind of coverage or price Use & Processing

Your rights

• Members have rights under federal law, exercised through the listed requests Account & Service Control

Under federal law, you have the right to:

• Members have rights under federal law, exercised through the listed requests Account & Service Control

• Send us a written request to see or get a copy of your PHI, including a request for a copy of your PHI through email. Remember, there’s a risk your PHI could be read by a third party when it’s sent unencrypted, meaning regular email. So we will first confirm that you want to get your PHI by unencrypted email before sending it to you. We will provide you a copy of your PHI usually within 30 days of your request. If we need more time, we will let you know.
• • Members can send a written request to see or get a copy of their PHI Account & Service Control
  • Anthem will confirm before sending PHI by unencrypted email Security & Safeguards
• Ask that we correct any PHI that you believe is wrong or incomplete. If someone else, such as your doctor, gave us the PHI, we’ll let you know so you can ask him or her to correct it. We may say “no” to your request, but we’ll tell you why in writing within 60 days.
• • Members can ask Anthem to correct PHI they believe is wrong or incomplete Account & Service Control
• Send us a written request not to use your PHI for treatment, payment, or healthcare operations activities. We may say “no” to your request, but we’ll tell you why in writing.
• • Members can request that PHI not be used for treatment, payment or healthcare operations, but Anthem may say no Use & Processing
• Request confidential communications. You can ask us to send your PHI or contact you using other ways that are reasonable. Also, let us know if you want us to send your mail to a different address if sending it to your home could put you in danger.
• • Members can request confidential communications Account & Service Control
• Send us a written request to ask us for a list of those with whom we’ve shared your PHI. We will provide you a list, usually within 60 days of your request. If we need more time, we will let you know.
• • Members can request a list of those with whom PHI was shared Account & Service Control
• Ask for a restriction for services you pay for out of your own pocket: If you pay in full for any medical services out of your own pocket, you have the right to ask for a restriction. The restriction would prevent the use or sharing of that PHI for treatment, payment, or operations reasons. If you or your care provider submits a claim to us, we may not agree to a restriction (see “Your rights” above). If a law requires sharing your information, we don’t have to agree to your restriction.
• • Members who pay in full out of pocket can ask for a restriction; Anthem may not agree in some cases Sharing & Disclosure
• Call Member Services at the phone number on your ID card to use any of these rights. A representative can give you the address to send the request. They can also give you any forms we have that may help you with this process.
• • To use any of these rights, call Member Services Account & Service Control

How we protect information

• Anthem says it protects PHI with policies and practices and must tell members of a breach it believes occurred Security & Safeguards

We’re dedicated to protecting your PHI, and we’ve set up a number of policies and information practices to help keep your PHI secure and private. If we believe your PHI has been breached, we must let you know.

• Anthem says it protects PHI with policies and practices and must tell members of a breach it believes occurred Security & Safeguards

We keep your oral, written, and electronic PHI safe using the right procedures, and through physical and electronic means. These safety measures follow federal and state laws. Some of the ways we keep your PHI safe include securing offices that hold PHI, password-protecting computers, and locking storage areas and filing cabinets. We require our employees to protect PHI through written policies and procedures. These policies limit access to PHI to only those employees who need the data to do their jobs. Employees are also required to wear ID badges to help keep unauthorized people out of areas where your PHI is kept. Also, where required by law, our business partners must protect the privacy of data we share with them as they work with us. They’re not allowed to give your PHI to others without your written permission, unless the law allows it and it’s stated in this notice.

• Safeguards: physical and electronic protections, limited employee access and business partner duties Security & Safeguards

Potential impact of other applicable laws

• HIPAA does not cancel other laws; where a law gives more privacy protection, Anthem follows it too Legal Rights & Agreement Rules

HIPAA, the federal privacy law, generally doesn’t cancel out other laws that give people greater privacy protections. As a result, if any state or federal privacy law requires us to give you more privacy protections, then we must follow that law in addition to HIPAA. One example is with Substance Use Disorder (SUD) information we may receive from Providers or programs regulated by federal law (42 CFR Part 2). All disclosures of SUD information must comply with all applicable Federal and State privacy laws, including 42 CFR Part 2. We are allowed to Use and Disclose SUD information for certain Treatment, Payment, and Health Care Operations activities. You have the right to consent to disclosure of SUD information in certain circumstances. You can revoke this consent in writing at any time.

• HIPAA does not cancel other laws; where a law gives more privacy protection, Anthem follows it too Legal Rights & Agreement Rules
• Substance use disorder information is covered by 42 CFR Part 2 and consent rules Legal Rights & Agreement Rules

To see more information

• More information is on Anthem's Privacy web page, which is not part of this source Legal Rights & Agreement Rules

To read more information about how we collect and use your information, your privacy rights, and other state and federal privacy laws, please visit our Privacy web page at anthem.com/privacy.

• More information is on Anthem's Privacy web page, which is not part of this source Legal Rights & Agreement Rules

Calling or texting you

• Anthem, its affiliates and vendors may call or text using an autodialer or artificial voice Use & Processing

We, including our affiliates and/or vendors, may call or text you by using an automatic telephone dialing system and/or an artificial voice. But we only do this in accordance with the Telephone Consumer Protection Act (TCPA). The calls may be about treatment options or other health-related benefits and services for you. If you don’t want to be contacted by phone, let the caller know or call 844-203-3796 to add your phone number to our Do Not Call list. We will then no longer call or text you.

• Anthem, its affiliates and vendors may call or text using an autodialer or artificial voice Use & Processing
• A member who does not want phone contact can tell the caller or call 844-203-3796 Account & Service Control

Complaints

• Members can file a privacy complaint with Anthem or HHS; Anthem says it will not retaliate Legal Rights & Agreement Rules

If you think we haven’t protected your privacy, you can file a complaint with us at the Member Services phone number on your ID card. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by visiting hhs.gov/ocr/privacy/hipaa/complaints/. We will not take action against you for filing a complaint.

• Members can file a privacy complaint with Anthem or HHS; Anthem says it will not retaliate Legal Rights & Agreement Rules

Contact information

• Members can call Member Services for help applying rights, filing complaints or discussing privacy Account & Service Control

You may call us at the Member Services phone number on your ID card. Our representatives can help you apply your rights, file a complaint, or talk with you about privacy issues.

• Members can call Member Services for help applying rights, filing complaints or discussing privacy Account & Service Control

Copies and changes

• Members can get a new copy of the notice at any time, including a paper copy Account & Service Control

You have the right to get a new copy of this notice at any time. Even if you have agreed to get this notice by electronic means, you still have the right to ask for a paper copy. We reserve the right to change this notice. A revised notice will apply to PHI we already have about you, as well as any PHI we may get in the future. We’re required by law to follow the privacy notice that’s in effect at this time. We may tell you about any changes to our notice through a newsletter, our website, or a letter.

• Members can get a new copy of the notice at any time, including a paper copy Account & Service Control
• Anthem reserves the right to change the notice; a revised notice applies to PHI it already has and will get Legal Rights & Agreement Rules
• Anthem may tell members about changes through a newsletter, its website or a letter Legal Rights & Agreement Rules

Effective date of this notice

• Original effective date was April 14, 2003; the latest revision is noted in the footer Legal Rights & Agreement Rules

The original effective date of this notice was April 14, 2003. The most recent revision is noted in the footer at the end of this document.

• Original effective date was April 14, 2003; the latest revision is noted in the footer Legal Rights & Agreement Rules

Breast reconstruction surgery benefits

• A covered mastectomy includes benefits that comply with the Women's Health and Cancer Rights Act of 1998 Legal Rights & Agreement Rules

A mastectomy that’s covered by your health plan includes benefits that comply with the Women’s Health and Cancer Rights Act of 1998, which provides for:

• A covered mastectomy includes benefits that comply with the Women's Health and Cancer Rights Act of 1998 Legal Rights & Agreement Rules

• Reconstruction of the breast(s) that underwent a covered mastectomy.
• • A covered mastectomy includes benefits that comply with the Women's Health and Cancer Rights Act of 1998 Legal Rights & Agreement Rules
• Surgery and reconstruction of the other breast to restore a symmetrical appearance.
• • A covered mastectomy includes benefits that comply with the Women's Health and Cancer Rights Act of 1998 Legal Rights & Agreement Rules
• Prostheses and coverage for physical complications related to all stages of a covered mastectomy, including lymphedema.
• • A covered mastectomy includes benefits that comply with the Women's Health and Cancer Rights Act of 1998 Legal Rights & Agreement Rules

You’ll pay your usual deductible, copay, and/or coinsurance. For details, contact your plan administrator.

• The member pays the usual deductible, copay and/or coinsurance for these benefits Charges & Financial Obligations

For more information about the Women’s Health and Cancer Rights Act, go to the United States Department of Labor website at dol.gov/agencies/ebsa/laws-and-regulations/laws/whcra.

• The member pays the usual deductible, copay and/or coinsurance for these benefits Charges & Financial Obligations

It’s important we treat you fairly

• Anthem follows federal civil rights laws, does not discriminate, and offers free aids and language help Legal Rights & Agreement Rules

We follow federal civil rights laws in our health programs and activities. We don’t discriminate, exclude people, or treat them differently based on race, color, national origin, sex, age, or disability. If you have disabilities, we offer free aids and services. If your main language isn’t English, we offer help for free through interpreters and other written languages. Call the Member Services number on your ID card for help (TTY/TDD:711).

• Anthem follows federal civil rights laws, does not discriminate, and offers free aids and language help Legal Rights & Agreement Rules

If you think we failed to offer these services or discriminated based on race, color, national origin, age, disability, or sex, you can file a complaint, also known as a grievance. You can file a complaint one of these ways:

• Members can file a discrimination complaint (grievance) with Anthem or HHS in four ways Legal Rights & Agreement Rules

• Write to Compliance Coordinator, P.O. Box 27401, Mail Drop VA2002-N160, Richmond, VA 23279.
• • Members can file a discrimination complaint (grievance) with Anthem or HHS in four ways Legal Rights & Agreement Rules
• File a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights at 200 Independence Avenue, SW; Room 509F, HHH Building; Washington, D.C. 20201.
• • Members can file a discrimination complaint (grievance) with Anthem or HHS in four ways Legal Rights & Agreement Rules
• Call 800-368-1019 (TDD: 800-537-7697).
• • Members can file a discrimination complaint (grievance) with Anthem or HHS in four ways Legal Rights & Agreement Rules
• Go online at ocrportal.hhs.gov/ocr/portal/lobby.jsf and fill out a complaint form at hhs.gov/ocr/complaints/index.html.
• • Members can file a discrimination complaint (grievance) with Anthem or HHS in four ways Legal Rights & Agreement Rules

Get help in your language

• Members can get this information in their preferred language for free and in another format Account & Service Control

One more right that you have is the right to get this information in your preferred language for free. If you’d like extra help to understand this in another language, call the Member Services number on your ID card (TTY/TDD: 711).

• Members can get this information in their preferred language for free and in another format Account & Service Control

Aside from helping you understand your privacy rights in another language, we also offer this notice in a different format for members with visual impairments. If you need a different format, please call the Member Services number on your ID card.

• Members can get this information in their preferred language for free and in another format Account & Service Control

Language assistance

• The same language-assistance statement is repeated in other languages Account & Service Control

Spanish

• The same language-assistance statement is repeated in other languages Account & Service Control

Tiene el derecho de obtener esta información y ayuda en su idioma en forma gratuita. Llame al número de Servicios para Miembros que figura en su tarjeta de identificación para obtener ayuda. (TTY/TDD: 711)

• The same language-assistance statement is repeated in other languages Account & Service Control

Chinese

您有權使用您的語言免費獲得該資訊和協助。請撥打您的 ID 卡上的成員服務號 碼尋求協助。(TTY/TDD: 711)

Vietnamese

Qu vị có quyền nhận miễn phí thông tin này và sự trợ giúp bằng ngôn ngữ của qu vị. Hãy gọi cho số Dịch Vụ Thành Viên trên thẻ ID của qu vị để được giúp đỡ. (TTY/TDD: 711)

Korean

귀하에게는 무료로 이 정보를 얻고 귀하의 언어로 도움을 받을 권리가 있습니다. 도움을 얻으려면 귀하의 ID 카드에 있는 회원 서비스 번호로 전화하십시오. (TTY/TDD: 711)

Tagalog

May karapatan kayong makuha ang impormasyon at tulong na ito sa ginagamit ninyong wika nang walang bayad. Tumawag sa numero ng Member Services na nasa inyong ID card para sa tulong. (TTY/TDD: 711)

Russian

Вы имеете право получить данную информацию и помощь на вашем языке бесплатно. Для получения помощи звоните в отдел обслуживания участников по номеру, указанному на вашей идентификационной карте. (TTY/TDD: 711)

Arabic

ا. اتصل برقم خدمات األعضاء الموجود على بطاقة التعريف الخاصة بك ًنيحق لك الحصول على هذه المعلومات والمساعدة بلغتك مجاً للمساعدة. (TTY/TDD: 711)

Armenian

Դուք իրավունք ունեք Ձեր լեզվով անվճար ստանալ այս տեղեկատվությունը և ցանկացած օգնություն: Օգնություն ստանալու համար զանգահարեք Անդամների սպասարկման կենտրոն՝ Ձեր ID քարտի վրա նշված համարով: (TTY/TDD: 711)

Language assistance

(continued)

Farsi

شما این حق را دارید که این اطالعات و کمکها را به صورت رایگان به زبان خودتان دریافت کنید. برای دریافت کمک به شماره مرکز خدمات اعضاء که بر روی کارت شناساییتان

درج شده است، تماس بگیرید. (TTY/TDD: 711)

French

Vous avez le droit d’accéder gratuitement à ces informations et à une aide dans votre langue. Pour cela, veuillez appeler le numéro des Services destinés aux membres qui figure sur votre carte d’identification. (TTY/TDD: 711)

Japanese

この情報と支援を希望する言語で無料で受けることができます。支援を受けるには、 IDカードに記載されているメンバーサービス番号に電話してください。(TTY/TDD: 711)

Haitian

Ou gen dwa pou resevwa enfòmasyon sa a ak asistans nan lang ou pou gratis. Rele nimewo Manm Sèvis la ki sou kat idantifikasyon ou a pou jwenn èd. (TTY/TDD: 711)

Italian

Ha il diritto di ricevere queste informazioni ed eventuale assistenza nella sua lingua senza alcun costo aggiuntivo. Per assistenza, chiami il numero dedicato ai Servizi per i membri riportato sul suo libretto. (TTY/TDD: 711)

Polish

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Punjabi

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Reviewed 2/2026

• The notice's footer states it was reviewed 2/2026 Legal Rights & Agreement Rules

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. and AMGP Georgia Managed Care Company, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Community Care Health Plan of Nevada, Inc. and Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by either Matthew Thornton Health Plan, Inc. or Anthem Health Plans of New Hampshire, Inc. In 17 southeastern counties of New York: Anthem HealthChoice Assurance, Inc. and Anthem HealthChoice HMO, Inc. In these same counties Anthem Blue Cross and Blue Shield HP is the trade name of Anthem HP, LLC. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc. trades as Anthem HealthKeepers providing HMO coverage, and their service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI) underwrites or administers PPO and indemnity policies and underwrites the out-of-network benefits in POS policies offered by Compcare Health Services Insurance Corporation. Compcare underwrites or administers HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

• Anthem Blue Cross and Blue Shield is a trade name of different insuring entities in different states Legal Rights & Agreement Rules
• In some states, the named entities underwrite or only administer different plan types Legal Rights & Agreement Rules
• The note also names New York and Virginia entities and a Virginia service area Legal Rights & Agreement Rules
• Anthem is an independent licensee of the Blue Cross and Blue Shield Association; Anthem is a registered trademark Content & IP Rights