HUMANA.

NEW YORK: CONFIDENTIALITY FOR DOMESTIC VIOLENCE VICTIMS & ENDANGERED INDIVIDUALS

• This notice summarizes a New York insurance law on confidentiality for covered people at risk Legal Rights & Agreement Rules

New York Insurance Law § 2612, with respect to all insurers regulated under New York Insurance Law, including health maintenance organizations ("HMOs"), provides in relevant part that if any person covered by an insurance policy delivers to the insurer a valid order of protection against the policyholder or other person covered by the policy, then the insurer is prohibited for the duration of the order from disclosing to the policyholder or other person the address and telephone number of the insured, or of any person or entity providing covered services to the insured. If a child is a covered person, then the right established by this section may be asserted by the child's parent or guardian.

• This notice summarizes a New York insurance law on confidentiality for covered people at risk Legal Rights & Agreement Rules
• With a valid order of protection, the insurer may not disclose the covered person's address and telephone number Sharing & Disclosure
• A child's parent or guardian can assert these rights for a covered child Account & Service Control

New York Insurance Law § 2612 also requires a health insurer, as defined in that section, to accommodate

• A covered person who says disclosure could endanger them can ask for claim communications by other means or places Account & Service Control

a reasonable request made by a person covered by an insurance policy or contract to receive communications of claim-related information by alternative means or at alternative locations if the person clearly states that disclosure of the information could endanger the person. Ifa child is the covered person, then this right may be asserted by the child's parent or guardian.

• A child's parent or guardian can assert these rights for a covered child Account & Service Control
• A covered person who says disclosure could endanger them can ask for claim communications by other means or places Account & Service Control

Except with the express consent of the person making the request, a health insurer may not disclose to the policyholder: (1) the address, telephone number, or any other personally identifying information of the person who made the request or child for whose benefit a request was made; (2) the nature of the health care services provided; or (3) the name or address of the provider of the covered services.

• Without the requester's consent, a health insurer may not tell the policyholder their details, services or provider Sharing & Disclosure

MAKING A REQUEST:

• A request is made through the Member Services number on the ID card or the Humana Privacy Office Account & Service Control

A request can be made by using the toll-free Member Services number on your ID card, or you may contact the Humana Privacy Office directly by using the contact information in the section below.

• A request is made through the Member Services number on the ID card or the Humana Privacy Office Account & Service Control

REVOKING A REQUEST:

• A request is revoked through Member Services or by writing to the Humana Privacy Office Account & Service Control

A request can be revoked by contacting the toll-free Member Services number on your ID card, or you may contact the Humana Privacy Office directly by using the address below:

• A request is revoked through Member Services or by writing to the Humana Privacy Office Account & Service Control

Humana Inc.

• A request is revoked through Member Services or by writing to the Humana Privacy Office Account & Service Control

Privacy Office 003/10911

• A request is revoked through Member Services or by writing to the Humana Privacy Office Account & Service Control

101 E. Main Street

• A request is revoked through Member Services or by writing to the Humana Privacy Office Account & Service Control

Louisville, KY 40202

• A request is revoked through Member Services or by writing to the Humana Privacy Office Account & Service Control

For your information the phone number for the New York State Domestic and Sexual Violence Hotline is 1-800-942-6906.

• The notice gives the New York State Domestic and Sexual Violence Hotline number for information Security & Safeguards

NYHHMWXEN 0713

NYHHMWXEN 0713