One notice combines three required yearly communications
The company says it must send members, each year, specific information about their rights and some of its duties to keep their information safe. This single document combines three of those required communications: a state notice of privacy practices, a HIPAA notice of privacy practices, and a notice about breast reconstruction surgery benefits.
Supporting quotations
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:
State notice of privacy practices
Health Insurance Portability and Accountability Act (HIPAA) notice of privacy practices
Breast reconstruction surgery benefits
Qualifications & exceptions
The three parts have different stated coverage: the state part names health, dental, vision and life insurance benefits, while the HIPAA part is introduced as covering medical, vision and dental information.
Not stated here
The stored text never uses the words Medicare or Group Retiree Solutions; those come from the document title in the publisher registration, so the stored text does not itself say which plans or members this copy is for.
Account & Service Control · User right or choice
Members can sign up to get these notices by email
The notice invites members to go paperless: they can sign up at the Anthem website to receive these notices by email and read them online or in the mobile app.
Supporting quotations
Would you like to go paperless and read this online or on your mobile app? Go to https://www.anthem.com and sign up to get these notices by email.
Not stated here
The text does not say whether signing up requires an existing member account or what happens to paper copies.
Legal Rights & Agreement Rules · Company commitment
State privacy law is followed and can be stricter than HIPAA
For handling health information, the company says it follows relevant state laws, which are sometimes stricter than the federal HIPAA privacy law. The state notice explains members' rights and the company's duties under state law, and applies to the health, dental, vision and life insurance benefits a member may have.
Supporting quotations
we follow relevant state laws, which are sometimes stricter than the federal HIPAA privacy law
Explains your rights and our duties under state law.
Applies to health, dental, vision, and life insurance benefits you may have.
Qualifications & exceptions
The scope list is limited to benefits the member may have; it does not say which benefits this particular member actually holds.
Not stated here
The text does not name which state laws apply or which states are covered.
Sharing & Disclosure · User right or choice
Your state may give extra rights to limit sharing
A member's state may give additional rights to limit how health information is shared. To learn more, the member is told to call the Member Services phone number on their ID card.
Supporting quotations
Your state may give you additional rights to limit sharing your health information. Please call the Member Services phone number on your ID card for more details.
Not stated here
The notice does not list the additional state rights or which states provide them, apart from the Maine rights stated later in the document.
Account & Service Control · User right or choice
Personal information is nonpublic data; you can see and correct it
In the state notice, personal information (PI) means nonpublic, private information that identifies the member and is often gathered in an insurance matter. The notice says the member has the right to see and correct their PI.
Supporting quotations
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.
Not stated here
This card does not explain how to make a request; the state-notice paragraph gives no procedure or time limit for seeing or correcting PI.
Use & Processing · Company practice
The company may collect, use and share personal information
The company may collect, use and share a member's personal information as described in the notice. It says its goal is to protect that information because it can be used to make judgments about the member's health, finances, character, habits, hobbies, reputation, career and credit.
Supporting quotations
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.
Qualifications & exceptions
Collection, use and sharing are permitted only as described in the notice.
Data Access & Collection · Company practice
Personal information may come from doctors, hospitals and other insurers
The company may receive a member's personal information from others, such as doctors, hospitals or other insurance companies.
Supporting quotations
We may receive your PI from others, such as doctors, hospitals, or other insurance companies.
Qualifications & exceptions
The examples are introduced with "such as", so the sources are not limited to those named.
Sharing & Disclosure · Permission or license
PI can be shared outside the company without approval in some cases
The company may share a member's personal information with others outside the company, in some cases without the member's approval. It says it takes reasonable measures to protect the information.
Supporting quotations
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.
Qualifications & exceptions
The permission is limited to "some cases".
Not stated here
This section does not say which cases allow sharing without approval or who the recipients are; later HIPAA sections list some uses and disclosures.
Use & Processing · Company commitment
Opt-out chances are announced when an activity requires them
If an activity requires the company to give the member a chance to opt out, the company says it will tell the member, and will explain how to say that the member does not want their personal information used or shared for that activity.
Supporting quotations
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.
Qualifications & exceptions
Applies only to activities that require an opt-out chance; the text does not say which activities those are.
Not stated here
The text does not list the opt-out activities or the method for opting out.
Cross-references
qualifies (model-proposed): PI can be shared outside the company without approval in some cases — qualifies: Sharing outside the company without approval in some cases is qualified by the statement that where an activity requires an opt-out chance, the member will be told and told how to opt out.
Legal Rights & Agreement Rules · Context
The HIPAA notice header covers medical, vision and dental information
A capitalized statement placed just before the HIPAA section says the notice describes how medical, vision and dental information about the member may be used and disclosed, and how the member can get access to it. It asks the member to review it carefully.
Supporting quotations
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 REVIEW IT CAREFULLY.
Qualifications & exceptions
It names medical, vision and dental information, not life insurance information, which the state notice separately lists.
Not stated here
The stored text places this statement after the state section and before the HIPAA heading, so it is not tagged as belonging to one part; whether it also frames the state part is not stated.
Legal Rights & Agreement Rules · Company commitment
Members' health and financial information is kept private; this notice is federally required
The company says it keeps the health and financial information of current and former members private as required by law, accreditation standards and its own internal rules. It also says federal law requires it to give this notice, which explains members' rights and the company's legal duties and privacy practices.
Supporting quotations
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.
Qualifications & exceptions
Covers current and former members.
Use & Processing · Permission or license
PHI may be collected, used and shared as allowed or required by law
The company says there are times it may collect, use and share a member's Protected Health Information (PHI) when the law, including the HIPAA privacy rule, allows or requires it. The paragraph introduces payment, healthcare operations and treatment activities as some of those times.
Supporting quotations
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:
Qualifications & exceptions
The three listed activities are only "some of those times", so the list is not stated to be complete.
Use & Processing · Company practice
PHI is used for payment: accounts, benefits and paying claims
For payment, the company collects, uses and shares PHI to take care of the member's account and benefits, or to pay claims for healthcare the member gets through the plan.
Supporting quotations
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.
Use & Processing · Company practice
PHI is used for the company's healthcare operations
The company collects, uses and shares PHI for its healthcare operations.
Supporting quotations
Healthcare operations: We collect, use, and share PHI for our healthcare operations.
Not stated here
The sentence does not say what counts as healthcare operations; it only names the category.
Use & Processing · Company practice
The company does not provide treatment but uses treatment information to offer services
The company says it does not provide treatment. It does collect, use and share information about a member's treatment to offer services that may help the member, including sharing information with others who are providing the member treatment.
Supporting quotations
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.
Qualifications & exceptions
The purpose is offering services that may help the member; the company states it does not itself provide treatment.
Legal Rights & Agreement Rules · Context
A footer line reads Effective May 2025
Between the treatment description and the examples, the stored text contains a form-code line ending in "Effective May 2025". This is the only dated line in the stored text. A later section says the notice's most recent revision is noted in the footer.
Supporting quotations
Effective May 2025
Not stated here
The text does not state that this line is the revision date the later section refers to; the line sits in the middle of the document, as a page footer would in a PDF.
Use & Processing · Company practice
Examples: payment records, benefit checks and explanation of benefits
As examples of how it uses information, the company says it keeps information on file about the member's premium and deductible payments, may give information to a doctor's office to confirm the member's benefits, and may share the explanation of benefits (EOB) with the subscriber of the plan for payment purposes.
Supporting quotations
We keep information on file about your premium and deductible payments.
We may give information to a doctor’s office to confirm your benefits.
We may share explanation of benefits (EOB) with the subscriber of your plan for payment purposes.
Qualifications & exceptions
Sharing the EOB is limited to the subscriber and to payment purposes.
These are described as examples of ways the information is used.
Not stated here
The text does not say whether the subscriber is always the member or may be a different person such as a policyholder.
Sharing & Disclosure · Company practice
Example: PHI may be shared with your doctor or hospital for treatment
The company may share a member's PHI with the member's doctor or hospital so that they may treat the member.
Supporting quotations
We may share PHI with your doctor or hospital so that they may treat you.
Use & Processing · Company practice
Examples: quality-of-care review and help with conditions like asthma or diabetes
The company may use PHI to review the quality of care and services the member gets, and to help the member with services for conditions such as asthma, diabetes or traumatic injury.
Supporting quotations
We may use PHI to review the quality of care and services you get.
We may use PHI to help you with services for conditions like asthma, diabetes, or traumatic injury.
Qualifications & exceptions
The named conditions are introduced with "like", so they are examples and not an exhaustive list.
Data Access & Collection · Company practice
Example: publicly or commercially available data about you may be collected and used
The company may collect and use publicly and/or commercially available data about the member, to support the member and help the member get health plan benefits and services.
Supporting quotations
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.
Not stated here
The text does not say which public or commercial sources are used or what kinds of data are collected.
Use & Processing · Company practice
Example: PHI may be used with technology to support services
The company may use PHI with technology to support and enable services provided to the member.
Supporting quotations
We may use PHI with technology to support and enable services provided to you.
Not stated here
The text does not say what technology is meant or whether it is operated by the company or by others.
Use & Processing · Permission or license
Example: PHI may be used to create, use or share de-identified data
The company may use a member's PHI to create, use or share de-identified data, as HIPAA allows.
Supporting quotations
We may use your PHI to create, use, or share de-identified data as allowed by HIPAA.
Qualifications & exceptions
Allowed only to the extent HIPAA permits.
Not stated here
The text does not say who receives de-identified data or for what uses.
Sharing & Disclosure · Permission or license
Example: PHI may be shared with health information exchanges
The company may use and share PHI directly or indirectly with health information exchanges for payment, healthcare operations and treatment. A member who does not want PHI shared in these situations is directed to the Anthem privacy web page for more information.
Supporting quotations
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 www.anthem.com/privacy for more information.
Qualifications & exceptions
Sharing is stated for payment, healthcare operations and treatment.
Not stated here
The notice points to a web page for "more information" and does not itself say whether a member can stop this sharing or how.
Account & Service Control · User right or choice
The company must give you access to your own PHI
Under the heading about sharing PHI with the member, the notice says the company must give the member access to the member's own PHI.
Supporting quotations
We must give you access to your own PHI.
Not stated here
This paragraph gives no procedure or time limit; the written-request process and timing appear in the later rights section.
Use & Processing · Company practice
The company may contact you about treatment options, other plans and reminders
The company may contact the member about treatment options or other health-related benefits and services. When the member or their dependents reach a certain age, it may tell them about other plans or programs they may be eligible for, including individual coverage. It may send reminders about routine medical checkups and tests, and members may get emails with limited PHI, such as welcome materials.
Supporting quotations
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.
Qualifications & exceptions
The emails are described as having limited PHI.
Not stated here
The text does not say what age triggers the notice about other plans.
Use & Processing · Company commitment
The paragraph ends: we will ask your permission before we contact you
The last sentence of the paragraph on sharing PHI with the member says the company will ask the member's permission before it contacts them.
Supporting quotations
We’ll ask your permission before we contact you.
Qualifications & exceptions
It follows the sentence about emails with limited PHI.
Not stated here
The sentence does not say whether the permission applies to every contact in the paragraph or only to the emails just before it, or how permission is asked for.
Cross-references
contrast (model-proposed): The company, affiliates and vendors may call or text using automated dialing or an artificial voice — contrast: The paragraph on sharing PHI with the member says the company will ask permission before it contacts the member, while the calling section says affiliates and vendors may call or text using automated dialing under the TCPA and the member can opt out afterwards. The notice does not reconcile the two.
Sharing & Disclosure · Restriction or exception
Outside treatment, payment, operations or research, written permission is usually needed
In most cases, if the company uses or shares a member's PHI outside of treatment, payment, operations or research activities, it has to get the member's written okay first.
Supporting quotations
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.
Qualifications & exceptions
"In most cases" means there are exceptions; later sections list other disclosures allowed without permission.
Sharing & Disclosure · Restriction or exception
Written permission is required for certain marketing, selling PHI and psychotherapy notes
The company must also get the member's written permission before using PHI for certain marketing activities, selling PHI, or sharing psychotherapy notes from the member's doctor or therapist.
Supporting quotations
We must also get your written permission before:
Using your PHI for certain marketing activities.
Selling your PHI.
Sharing any psychotherapy notes from your doctor or therapist.
Qualifications & exceptions
Marketing is limited to "certain" activities.
Not stated here
The text does not say which marketing activities need permission.
Account & Service Control · User right or choice
Written permission may be needed in other situations and can always be cancelled
The company may also need the member's written permission in situations not listed. The member always has the right to cancel any written permission they have given, at any time.
Supporting quotations
We may also need your written permission for other situations not mentioned above. You always have the right to cancel any written permission you have given at any time.
Not stated here
This paragraph does not say how to cancel or the effect on actions already taken; the Authorization section gives the written-cancellation rule.
Sharing & Disclosure · User right or choice
You can tell the company to share with family or friends and in emergencies
The member has the right and choice to tell the company to share information with family, close friends or others involved with the member's current treatment or payment for care, and to share information in an emergency or disaster relief situation.
Supporting quotations
You have the right and choice to tell us to:
Share information with your family, close friends, or others involved with your current treatment or payment for your care.
Share information in an emergency or disaster relief situation.
Qualifications & exceptions
Sharing with family or friends is limited to people involved with current treatment or payment for care.
Sharing & Disclosure · Permission or license
If you cannot state a preference, PHI may be shared if in your best interest
If a member cannot state a preference, for example in an emergency or if the member is unconscious, the company may share the member's PHI if it believes doing so is in the member's best interest.
Supporting quotations
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.
Qualifications & exceptions
Depends on the company's own belief about the member's best interest.
Information may be shared to lessen a serious and likely threat
The company may also share a member's information when needed to lessen a serious and likely threat to the member's health or safety.
Supporting quotations
We may also share your information when needed to lessen a serious and likely threat to your health or safety.
Not stated here
The sentence does not name who may receive the information.
Sharing & Disclosure · Permission or license
Information may be shared for other reasons, usually for the public good
The company is allowed, and in some cases required, to share information in other ways, usually for the good of the public, such as public health and research. The notice then lists specific purposes.
Supporting quotations
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:
Qualifications & exceptions
The sharing is limited to the specific purposes listed; the sentence says "usually" for the public good.
Sharing for public health and safety, including reporting suspected abuse
The company may share information to help with public health and safety issues, such as preventing disease, helping with product recalls, reporting adverse reactions to medicines, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone's health or safety.
Supporting quotations
Helping with public health and safety issues, such as:
– Preventing disease
– Helping with product recalls
– Reporting adverse reactions to medicines
– Reporting suspected abuse, neglect, or domestic violence
– Preventing or reducing a serious threat to anyone’s health or safety
Qualifications & exceptions
The items are introduced with "such as", so they are examples.
Not stated here
The text does not name the agencies or others who receive the information.
Sharing & Disclosure · Permission or license
Information may be shared for health research
The company may share information for doing health research.
Supporting quotations
Doing health research.
Not stated here
The text states no conditions, such as review or de-identification, for research use here. The earlier permission sentence treats research as outside the written-permission requirement.
Legal Rights & Agreement Rules · Permission or license
Information may be shared when the law requires, in lawsuits and for HHS enforcement
The company may share information to obey the law when it requires sharing, to respond to lawsuits and legal actions, and to respond to the Secretary of Human and Health Services (as the notice words it) for HIPAA rules compliance and enforcement purposes.
Supporting quotations
Obeying the law, if it requires sharing your information.
Responding to lawsuits and legal actions.
Responding to the Secretary of Human and Health Services for HIPAA rules compliance and enforcement purposes.
Qualifications & exceptions
Obeying the law applies only if the law requires sharing.
Sharing & Disclosure · Permission or license
Information may be shared with organ donation groups
The company may share information in responding to organ donation groups for research and certain reasons.
Supporting quotations
Responding to organ donation groups for research and certain reasons.
Not stated here
The text does not say what the "certain reasons" are.
Sharing & Disclosure · Permission or license
Information may be shared for workers' compensation, law enforcement and government requests
The company may share information in addressing workers' compensation, law enforcement and other government requests, and to alert proper authorities if it believes the member may be a victim of abuse or other crimes.
Supporting quotations
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.
Qualifications & exceptions
Alerting authorities depends on the company's own belief that the member may be a victim.
Not stated here
The text does not say what level of government request or legal process is needed.
Sharing & Disclosure · Permission or license
PHI may be shared with your group health plan when enrolled through an employer
If the member is enrolled through an employer, the company may share PHI with the member's group health plan. If the employer pays the premium or part of it but does not pay the health insurance claims, the employer can only have the PHI for permitted reasons and is required by law to protect it.
Supporting quotations
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.
Qualifications & exceptions
Applies to members enrolled through an employer.
The limit on employer access applies where the employer pays premium but not claims.
Not stated here
The text does not say what the "permitted reasons" are, or what applies when the employer does pay claims. It also does not say whether a retiree plan sponsor counts as an employer.
Use & Processing · Company commitment
Written permission is needed before PHI is used for any purpose not stated in the notice
The company says it will get the member's written permission before it uses or shares PHI for any purpose not stated in this notice.
Supporting quotations
We’ll get your written permission before we use or share your PHI for any purpose not stated in this notice.
Qualifications & exceptions
Applies to purposes not stated in the notice; the stated uses and disclosures do not need this permission unless another part of the notice says so.
Account & Service Control · User right or choice
You can cancel your permission in writing, but past uses cannot be undone
The member may cancel a permission at any time, in writing. The company will then stop using the PHI for that purpose. If the company has already used or shared the PHI with the member's permission, it cannot undo what it did before the member told it to stop.
Supporting quotations
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.
Qualifications & exceptions
Cancellation must be in writing and only stops later use for that purpose.
Use & Processing · Restriction or exception
Genetic information is not used to decide coverage or price
The company says it cannot use a member's genetic information to decide whether to give coverage or to decide the price of that coverage.
Supporting quotations
We cannot use your genetic information to decide whether we’ll give you coverage or decide the price of that coverage.
Data Access & Collection · Company practice
Race, ethnicity, language, sexual orientation and gender identity information may be collected and used to help you
The company may collect, infer, receive and/or maintain information about the member's race, ethnicity, language, sexual orientation and gender identity, and says it protects the information as described in the notice. It may use it to help the member, including identifying specific needs, developing programs and educational materials, and offering interpretation services.
Supporting quotations
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.
Qualifications & exceptions
The uses are introduced with "including", so the listed purposes are examples.
Not stated here
The text does not say how the information is inferred or from what.
Use & Processing · Restriction or exception
That information is not used for coverage decisions or shared with unauthorized persons
The company says it does not use race, ethnicity, language, sexual orientation and gender identity information to decide whether it will give coverage, what kind of coverage, or the price of that coverage, and that it does not share this information with unauthorized persons.
Supporting quotations
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.
Not stated here
The text does not say who counts as an authorized person.
Account & Service Control · Procedure
Federal rights are listed and exercised through Member Services
The notice lists rights the member has under federal law. To use any of them, the member calls Member Services at the phone number on the ID card; a representative can give the address for the request and any forms that may help.
Supporting quotations
Under federal law, you have the right to:
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.
Qualifications & exceptions
Several rights require a written request; the call step is how the member gets the address and forms.
Account & Service Control · User right or choice
Right to see or get a copy of your PHI, with an email warning
The member may send a written request to see or get a copy of their PHI, including a request to receive the copy by email. Because unencrypted email may be read by a third party, the company first confirms that the member wants the PHI sent by unencrypted email. It usually provides the copy within 30 days of the request and says it will tell the member if it needs more time.
Supporting quotations
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.
Qualifications & exceptions
The request must be in writing.
The 30-day period is stated as "usually"; the company can take longer if it tells the member.
Not stated here
The text does not state a maximum extension or any fee.
Account & Service Control · User right or choice
Right to ask for corrections to your PHI
The member may ask the company to correct PHI the member believes is wrong or incomplete. If someone else, such as the member's doctor, gave the company the PHI, the company will say so the member can ask that person to correct it. The company may say no, but will explain why in writing within 60 days.
Supporting quotations
Ask that we correct your 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.
Qualifications & exceptions
The company may refuse, with a written reason within 60 days.
Use & Processing · User right or choice
Right to ask the company not to use your PHI for treatment, payment or operations
The member may send a written request asking the company not to use their PHI for treatment, payment or healthcare operations activities. The company may say no, but will explain why in writing.
Supporting quotations
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.
Qualifications & exceptions
It is a request the company may refuse.
Account & Service Control · User right or choice
Right to request confidential communications
The member can ask the company to send PHI or contact the member in other reasonable ways, and can ask that mail be sent to a different address if sending it to the home could put the member in danger.
Supporting quotations
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.
Qualifications & exceptions
The other ways must be reasonable.
Sharing & Disclosure · User right or choice
Right to a list of those with whom your PHI was shared
The member may send a written request for a list of those with whom the company has shared the member's PHI. The company usually provides the list within 60 days and says it will tell the member if it needs more time.
Supporting quotations
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.
Qualifications & exceptions
The 60-day period is stated as "usually".
Not stated here
The text does not say which disclosures appear on the list or what period it covers.
Sharing & Disclosure · User right or choice
Right to ask for a restriction on services you pay for yourself
If the member pays in full out of pocket for medical services, the member has the right to ask for a restriction that would prevent use or sharing of that PHI for treatment, payment or operations reasons. If the member or the provider submits a claim to the company, the company may not agree to a restriction. If a law requires sharing the information, the company does not have to agree to a restriction.
Supporting quotations
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 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.
Qualifications & exceptions
The right is to ask; the company may decline if a claim is submitted by the member or the provider, or if a law requires sharing.
Not stated here
The parenthetical "see “Your rights” above" does not say which earlier right it points to, and the stored text has no further explanation.
The company has policies to keep PHI secure and will tell you of a breach it believes occurred
The company says it is dedicated to protecting PHI and has set up policies and information practices to keep it secure and private. If the company believes a member's PHI has been breached, it says it must tell the member.
Supporting quotations
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.
Qualifications & exceptions
The notice duty depends on the company believing a breach occurred.
Not stated here
The text does not say how or how quickly the member would be told.
Security & Safeguards · Company practice
Physical, electronic and staff safeguards protect PHI
The company says it keeps oral, written and electronic PHI safe using physical and electronic procedures that follow federal and state laws. Examples include securing offices that hold PHI, password-protecting computers and locking storage areas and filing cabinets. Employees must protect PHI under written policies, access is limited to employees who need the data for their jobs, and employees must wear ID badges to keep unauthorized people out of areas where PHI is kept.
Supporting quotations
We keep your oral, written, and electronic PHI safe using the right procedures, and through physical and electronic ways. 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.
Qualifications & exceptions
The measures are "some of the ways", not a complete list.
Not stated here
The text does not mention encryption standards or independent audits.
Sharing & Disclosure · Restriction or exception
Business partners must protect shared data where the law requires
Where required by law, the company's business partners must protect the privacy of data the company shares with them. They are not allowed to give a member's PHI to others without the member's written permission, unless the law allows it and it is stated in this notice.
Supporting quotations
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.
Qualifications & exceptions
The duty applies "where required by law".
Not stated here
The text does not say who the business partners are.
Legal Rights & Agreement Rules · Company commitment
State or federal laws that give more protection are followed in addition to HIPAA
The notice says HIPAA generally does not cancel other laws that give people greater privacy protections. If a state or federal privacy law requires the company to give more privacy protections, the company must follow that law in addition to HIPAA.
Supporting quotations
HIPAA, the federal privacy law, generally doesn’t cancel 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.
Qualifications & exceptions
"Generally" signals that HIPAA can override in some cases; the text does not say which.
Sharing & Disclosure · Restriction or exception
Substance use disorder information has its own consent rules under 42 CFR Part 2
As an example of other laws, the notice mentions Substance Use Disorder (SUD) information the company may receive from providers or programs regulated by federal law (42 CFR Part 2). All disclosures of that information must comply with applicable federal and state privacy laws, including 42 CFR Part 2. The company may use and disclose SUD information for certain treatment, payment and health care operations activities. The member has the right to consent to disclosure of SUD information in certain circumstances and can revoke that consent in writing at any time.
Supporting quotations
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 such SUD information must comply with 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 the disclosure of SUD information in certain circumstances. You can revoke this consent in writing at any time.
Qualifications & exceptions
Use and disclosure is allowed only for "certain" treatment, payment and operations activities, and the consent right applies "in certain circumstances".
Not stated here
The cited federal regulation is not part of the supplied text, and the notice does not say which activities or circumstances are meant.
More detail on collection, use and privacy rights is on the Anthem privacy web page
For more information on how the company collects and uses information, on privacy rights and on other state and federal privacy laws, the notice points the member to the Anthem privacy web page at www.anthem.com/privacy.
Supporting quotations
To read more information about how we collect and use your information, your privacy rights, and details about other state and federal privacy laws, please visit our Privacy web page at www.anthem.com/privacy.
Not stated here
The text of the linked web page was not supplied with this document and is not analyzed here, so anything on that page is unknown.
Use & Processing · Permission or license
The company, affiliates and vendors may call or text using automated dialing or an artificial voice
The company, including its affiliates and/or vendors, may call or text the member using an automatic telephone dialing system and/or an artificial voice, but says it does so only in accordance with the Telephone Consumer Protection Act (TCPA). The calls may be about treatment options or other health-related benefits and services for the member.
Supporting quotations
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.
Qualifications & exceptions
Limited by the company's statement that it acts in accordance with the TCPA.
Not stated here
The statute is cited by name only and is not part of the supplied text; the notice does not say whether the member's consent is collected before calls.
Account & Service Control · User right or choice
You can stop calls and texts by telling the caller or joining the Do Not Call list
A member who does not want to be contacted by phone can tell the caller, or call 1-844-203-3796 to add their phone number to the company's Do Not Call list. The company says it will then no longer call or text.
Supporting quotations
If you don’t want to be contacted by phone, just let the caller know or call 1-844-203-3796 to add your phone number to our Do Not Call list. We will then no longer call or text you.
Not stated here
The text does not say how long it takes for the request to take effect.
Legal Rights & Agreement Rules · Procedure
You can complain to the company or to the federal Office for Civil Rights
A member who thinks the company has not protected their privacy can file a complaint with the company at the Member Services phone number on the ID card, and can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights through its website.
Supporting quotations
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/.
Account & Service Control · Company commitment
The company will not take action against you for filing a complaint
The company says it will not take action against a member for filing a privacy complaint.
Supporting quotations
We will not take action against you for filing a complaint.
Not stated here
The text does not define what counts as "action".
Account & Service Control · Procedure
Member Services can help apply your rights and file complaints
The member can call the Member Services phone number on the ID card. Representatives can help the member apply their rights, file a complaint or talk about privacy issues.
Supporting quotations
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.
Account & Service Control · User right or choice
You can get a new copy of this notice at any time, including on paper
The member has the right to get a new copy of this notice at any time. A member who has agreed to get the notice electronically still has the right to ask for a paper copy.
Supporting quotations
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.
Legal Rights & Agreement Rules · Permission or license
The company can change the notice, and the revised notice applies to PHI it already has
The company reserves the right to change this notice. A revised notice will apply to PHI the company already has about the member as well as PHI it may get in the future. The company says it is required by law to follow the privacy notice in effect at this time.
Supporting quotations
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.
Qualifications & exceptions
The revision applies to both existing and future PHI.
Legal Rights & Agreement Rules · Company practice
Changes may be announced through a newsletter, the website or a letter
The company may tell members about changes to the notice through a newsletter, its website or a letter.
Supporting quotations
We may tell you about any changes to our notice through a newsletter, our website, or a letter.
Qualifications & exceptions
The wording is "may", so the notice does not promise direct notice of every change.
Not stated here
The text does not say how far ahead of a change members are told.
Legal Rights & Agreement Rules · Context
Original effective date is April 14, 2003; the latest revision is noted in the footer
The notice says its original effective date was April 14, 2003, and that its most recent revision is noted in the footer at the end of the document.
Supporting quotations
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.
Not stated here
The stored text has a form-code line reading "Effective May 2025" in the middle of the document, but it does not state that this is the footer revision referred to here, and the stored text ends with a trade-name paragraph that carries no date.
Cross-references
related (model-proposed): A footer line reads Effective May 2025 — references: The effective-date section says the latest revision is noted in the footer; the only dated footer-style line is the form-code line reading Effective May 2025, though the text does not state they are the same.
Legal Rights & Agreement Rules · Context
Maine residents have additional rights under the Maine Insurance Information and Privacy Protection Act
A section for Maine residents says the Maine Insurance Information and Privacy Protection Act gives consumers in Maine additional privacy rights, which the section then lists.
Supporting quotations
FOR MAINE RESIDENTS: Maine Notice of Additional Privacy Rights
The Maine Insurance Information and Privacy Protection Act provides consumers in Maine with the following additional rights.
Qualifications & exceptions
Stated for consumers in Maine.
Not stated here
The statute is named but its text is not supplied.
Account & Service Control · User right or choice
Maine: access, correction and a rebuttal statement for recorded personal information
Under the Maine section, a consumer has the right to access their recorded personal information in the possession or control of a regulated insurance entity, to request correction if they believe it is inaccurate, and to add a rebuttal statement to the file if there is a dispute.
Supporting quotations
The right to:
Obtain access to the consumer’s recorded personal information in the possession or control of a regulated insurance entity.
Request correction if the consumer believes the information to be inaccurate.
Add a rebuttal statement to the file if there is a dispute.
Qualifications & exceptions
Applies under Maine law to consumers in Maine and to a regulated insurance entity.
Not stated here
The text does not say how to make these requests or how long the entity has to respond.
Account & Service Control · User right or choice
Maine: right to know reasons for an adverse underwriting decision
Under the Maine section, a consumer has the right to know the reasons for an adverse underwriting decision. A previous adverse underwriting decision may not be used as the basis for a later one unless the carrier makes an independent evaluation of the underlying facts.
Supporting quotations
Know the reasons for an adverse underwriting decision (previous adverse underwriting decisions may not be used as the basis for subsequent underwriting decisions unless the carrier makes an independent evaluation of the underlying facts).
Qualifications & exceptions
A previous decision can serve as a basis only if the carrier independently evaluates the underlying facts.
Account & Service Control · User right or choice
Maine: protection from pretext interviews, with very narrow exceptions
Under the Maine section, with very narrow exceptions, a consumer has the right not to be subjected to pretext interviews.
Supporting quotations
With very narrow exceptions, not be subjected to pretext interviews.
Qualifications & exceptions
Subject to very narrow exceptions.
Not stated here
The text does not define pretext interviews or list the exceptions.
Legal Rights & Agreement Rules · Company commitment
Covered mastectomies include Women's Health and Cancer Rights Act benefits
A mastectomy covered by the health plan includes benefits that comply with the Women's Health and Cancer Rights Act of 1998. These are reconstruction of the breast that underwent a covered mastectomy, surgery and reconstruction of the other breast to restore a symmetrical appearance, and prostheses and coverage for physical complications related to all stages of a covered mastectomy, including lymphedema.
Supporting quotations
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:
Reconstruction of the breast(s) that underwent a covered mastectomy.
Surgery and reconstruction of the other breast to restore a symmetrical appearance.
Prostheses and coverage for physical complications related to all stages of a covered mastectomy, including lymphedema.
Qualifications & exceptions
Applies where a mastectomy is covered by the member's health plan.
Not stated here
The statute is named but its text is not supplied; the benefits actually available depend on the member's plan.
Charges & Financial Obligations · Company practice
You pay your usual deductible, copay or coinsurance for these benefits
For the breast reconstruction benefits, the member pays the usual deductible, copay and/or coinsurance. For details the member is told to contact the plan administrator.
Supporting quotations
You’ll pay your usual deductible, copay, and/or coinsurance. For details, contact your plan administrator.
Not stated here
The amounts are not given; they depend on the member's plan.
Legal Rights & Agreement Rules · Procedure
More on the Women's Health and Cancer Rights Act is on the Department of Labor website
For more information about the Women's Health and Cancer Rights Act, the notice points to the U.S. Department of Labor website.
Supporting quotations
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.
Not stated here
The linked page is not supplied.
Legal Rights & Agreement Rules · Company commitment
The company follows federal civil rights laws and does not discriminate
The company says it follows federal civil rights laws in its health programs and activities. It says it does not discriminate, exclude people or treat them differently based on race, color, national origin, sex, age or disability.
Supporting quotations
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.
Qualifications & exceptions
Stated for the company's health programs and activities.
Account & Service Control · User right or choice
Free aids and services for disabilities, and free language help
For members with disabilities the company offers free aids and services. If a member's main language is not English, it offers free help through interpreters and other written languages. A member can call the Member Services number on the ID card for help (TTY/TDD: 711).
Supporting quotations
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).
Legal Rights & Agreement Rules · Procedure
How to file a discrimination complaint
A member who thinks the company failed to offer these services or discriminated based on race, color, national origin, age, disability or sex can file a complaint, also called a grievance. The notice lists four ways: write to the Compliance Coordinator at a Richmond, Virginia post office box; file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at its Washington, D.C. address; call 1-800-368-1019 (TDD: 1-800-537-7697); or go online to the Office for Civil Rights complaint portal and fill out a complaint form.
Supporting quotations
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 through one of these ways:
Write to Compliance Coordinator, P.O. Box 27401, Mail Drop VA2002-N160 Richmond, VA 23279.
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.
Call 1-800-368-1019 (TDD: 1-800-537-7697).
Go online at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf and fill out a complaint form at https://www. hhs.gov/ocr/complaints/index.html.
Qualifications & exceptions
The grounds listed are race, color, national origin, age, disability and sex.
Account & Service Control · User right or choice
You can get this information in your language for free
The notice says one more right the member has is to get this information in their language for free. A member who wants extra help to understand it in another language can call the Member Services number on the ID card (TTY/TDD: 711).
Supporting quotations
One more right that you have is to get this information in your 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).
Not stated here
The text does not list which languages are available.
Account & Service Control · User right or choice
The notice is also offered in a different format for members with visual impairments
In addition to language help, the company offers this notice in a different format for members with visual impairments. A member who needs a different format can call the Member Services number on the ID card.
Supporting quotations
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.
Not stated here
The text does not say which formats are available.
Legal Rights & Agreement Rules · Context
Anthem Blue Cross and Blue Shield is a trade name of different companies in each state
The notice says Anthem Blue Cross and Blue Shield is a trade name used by different legal entities depending on the state: for example Rocky Mountain Hospital and Medical Service, Inc. in Colorado and Nevada; Anthem Health Plans, Inc. in Connecticut; Anthem Insurance Companies, Inc. in Indiana; two Blue Cross Blue Shield plan companies in Georgia; Anthem Health Plans of Kentucky, of Maine, of New Hampshire and of Virginia; RightCHOICE Managed Care, Healthy Alliance Life Insurance Company and HMO Missouri in Missouri outside 30 Kansas City area counties; Anthem HealthChoice entities and Anthem HP, LLC in 17 southeastern New York counties; Community Insurance Company in Ohio; and Blue Cross Blue Shield of Wisconsin and Compcare in Wisconsin. In Virginia, Anthem HealthKeepers is the trade name of the affiliate HealthKeepers, Inc. providing HMO coverage, with a stated service area of all Virginia except the City of Fairfax, the Town of Vienna and the area east of State Route 123.
Supporting quotations
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, 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 Community Care Health Plan of Georgia, 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.
In Nevada: Rocky Mountain Hospital and Medical Service, Inc.
In New Hampshire: 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.
Qualifications & exceptions
Missouri excludes 30 counties in the Kansas City area; the New York entry covers only 17 southeastern counties.
Not stated here
The text does not say which entity applies to a particular member, plan or group; no state or entity is tied to the group retiree plan named in the document title.
No entity is listed for states other than those named.
Charges & Financial Obligations · Context
Some entities underwrite benefits and others only administer, including self-funded plans
The trade-name paragraph also describes who underwrites and who administers. HMO products in Colorado and Nevada are underwritten by HMO Colorado, Inc. In Missouri, RIT and certain affiliates administer non-HMO benefits underwritten by Healthy Alliance Life Insurance Company and HMO benefits underwritten by HMO Missouri, Inc., and only provide administrative services for self-funded plans, without underwriting benefits. In New Hampshire, HMO plans are administered by Anthem Health Plans of New Hampshire and underwritten by Matthew Thornton Health Plan, Inc. In Wisconsin, Compcare underwrites or administers HMO or POS policies.
Supporting quotations
HMO products underwritten by HMO Colorado, 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.
HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc.
Compcare underwrites or administers HMO or POS policies.
Qualifications & exceptions
The self-funded-plan statement is made for Missouri (RIT and certain affiliates) only.
Not stated here
The text does not say whether the member's group coverage is self-funded or insured, so which role applies to this document's audience is unknown.
Legal Rights & Agreement Rules · Context
The companies are independent licensees of the Blue Cross and Blue Shield Association
The notice says the companies are independent licensees of the Blue Cross and Blue Shield Association, and that Anthem is a registered trademark of Anthem Insurance Companies, Inc.
Supporting quotations
Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.