This notice combines three required yearly communications
The document says the insurer is required each year to send members specific information about their rights and some of its duties, and that this one notice combines three of those yearly communications: a state notice of privacy practices, a HIPAA notice of privacy practices, and a breast reconstruction surgery benefits notice. An all-caps statement 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. Reading limits: the stored text never names Group Retiree Solutions or retirees and never defines ’we’. The only company named is WellPoint Life & Health Insurance Company, in the final line (coverage is provided by it), so the audience and the identity of ’we’ are taken from the document registration and that last line, not from a definition.
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
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.
Qualifications & exceptions
The all-caps statement names medical, vision and dental information; the state section separately says it applies to health, dental, vision and life insurance benefits.
Not stated here
The stored text does not mention Group Retiree Solutions or retirees, so which plan population receives this notice is not stated in the text.
'We' and 'us' are never defined; WellPoint Life & Health Insurance Company appears only in the last line.
Legal Rights & Agreement Rules · Company commitment
State privacy laws apply and can be stricter than HIPAA
The state section says that in handling health information the insurer follows relevant state laws, which are sometimes stricter than the federal HIPAA privacy law. This state notice explains member rights and insurer duties under state law and applies to the health, dental, vision, and life insurance benefits the member may have. The member’s state may give additional rights to limit the sharing of health information; for more details the member is told to call the Member Services phone number on the ID card. This section does not list the state-specific rights; the only state-specific rights set out in the document are the Maine rights in a later section.
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.
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.
Qualifications & exceptions
'Sometimes stricter' and 'may give' are hedged; the text does not say which states or rules are stricter.
The notice applies to benefits the member 'may have', so only benefits actually held.
Not stated here
Which state rights exist for the member's state, and what limits on sharing they allow, are not described here.
Legal Rights & Agreement Rules · Company commitment
Insurer says it keeps member health and financial information private and must give this notice
The HIPAA section says the insurer keeps the health and financial information of its 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 to explain member rights and the insurer’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
The commitment covers current and former members; it is stated as a general commitment, with detail in later sections on permitted sharing and safeguards.
Not stated here
The accreditation standards and internal rules are not supplied.
Legal Rights & Agreement Rules · Context
A form line in the text shows an effective date of May 2025
A line of form identifiers in the stored text reads ’Y0114_26_3016239_0000_NM_C Effective May 2025 1082691MUSENWLP_0005’. The notice later says its original effective date was April 14, 2003 and that the most recent revision is noted in the footer. The line appears between the treatment paragraph and the examples, which suggests a repeated page footer from the PDF, so it is read as the revision marker. That reading rests on its position and the word ’Effective’, not on a statement tying the two together.
Supporting quotations
Effective May 2025
Qualifications & exceptions
Only the words 'Effective May 2025' state a date; the other characters are identifiers.
Not stated here
Whether this line is the footer the 'Effective date' section refers to is inferred, not stated.
The notice does not say how long May 2025 has been in effect or whether a later revision exists.
Legal Rights & Agreement Rules · Company commitment
State or federal laws that give more privacy protection are also followed
The notice says HIPAA generally does not cancel other laws that give people greater privacy protections. If any state or federal privacy law requires the insurer to give more privacy protections, the insurer 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' leaves room for exceptions that the notice does not name.
Not stated here
Which other laws apply is not listed beyond the SUD example.
Legal Rights & Agreement Rules · Restriction or exception
Substance use disorder information from regulated programs has extra rules and a consent right
As an example of a stricter law, the notice mentions substance use disorder (SUD) information the insurer may receive from providers or programs regulated by federal law (42 CFR Part 2). It says all disclosures of such SUD information must comply with applicable federal and state privacy laws, including 42 CFR Part 2. The insurer says it is allowed to use and disclose SUD information for certain treatment, payment, and health care operations activities. The member has the right to consent to the disclosure of SUD information in certain circumstances and can revoke that consent in writing at any time. The legal citation is quoted as written and is not supplied in the text.
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 for treatment, payment and health care operations is allowed only for 'certain' activities.
The consent right applies 'in certain circumstances'.
Not stated here
Which activities and circumstances are meant is not specified; the content of 42 CFR Part 2 is not supplied.
Legal Rights & Agreement Rules · Context
More privacy information is on the Privacy web page
The notice points readers to its Privacy web page at www.wellpoint.com/privacy for more information about how it collects and uses information, privacy rights, and other state and federal privacy laws. That page is not part of the supplied text, so anything it adds is unknown here.
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.wellpoint.com/privacy.
Qualifications & exceptions
A pointer to a web page, not a statement that its content is part of this notice.
Not stated here
The content of the Privacy web page is not supplied.
Legal Rights & Agreement Rules · User right or choice
You can complain to the insurer or to the federal Office for Civil Rights; no action will be taken against you
If the member thinks the insurer has not protected their privacy, they can file a complaint with the insurer through the Member Services phone number on the ID card. They may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights through the web address given. The insurer says it will not take action against the member for filing a complaint. The Contact information section adds that Member Services representatives can help apply rights, file a complaint, or talk about privacy issues.
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/.
We will not take action against you for filing a complaint.
Our representatives can help you apply your rights, file a complaint, or talk with you about privacy issues.
Qualifications & exceptions
The no-retaliation statement refers to filing a complaint.
Not stated here
Deadlines and how the insurer handles complaints are not described.
Legal Rights & Agreement Rules · Permission or license
Insurer may change the notice, and a revised notice applies to existing and future PHI
The insurer reserves the right to change the notice. A revised notice will apply to PHI it already has about the member, as well as any PHI it may get in the future. It says it is required by law to follow the privacy notice that is in effect at this time. It may tell the member about changes through a newsletter, its website, or a letter. The wording ’may tell’ does not promise individual notice of every change, and no advance period is given.
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.
We may tell you about any changes to our notice through a newsletter, our website, or a letter.
Qualifications & exceptions
Notice of changes is something the insurer 'may' do, by newsletter, website or letter.
The insurer states it follows the notice in effect at the time.
Not stated here
No advance-notice period or objection process is described for changes.
Legal Rights & Agreement Rules · Context
Original effective date was April 14, 2003; the latest revision is in the footer
The notice says its original effective date was April 14, 2003, and that the most recent revision is noted in the footer at the end of the document. In the stored text, the only dated revision line is the form line reading ’Effective May 2025’, which sits earlier in the text; that is the likely footer, but the notice does not say so.
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.
Qualifications & exceptions
The notice itself gives no revision date, only a pointer to the footer.
Not stated here
Whether the 'Effective May 2025' form line is the footer referred to is an inference.
Cross-references
related (model-proposed): A form line in the text shows an effective date of May 2025 — references: The effective date paragraph points to a revision noted in the footer; the form line reading 'Effective May 2025' is the likely footer, though the notice does not say so.
Legal Rights & Agreement Rules · User right or choice
Maine residents can learn reasons for an adverse underwriting decision and are protected from most pretext interviews
The Maine section also lists the right to know the reasons for an adverse underwriting decision. A parenthetical says 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. It also lists the right, with very narrow exceptions, not to be subjected to pretext interviews. These apply to Maine residents as set out in the Maine section.
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).
With very narrow exceptions, not be subjected to pretext interviews.
Qualifications & exceptions
Prior adverse decisions can be used only after an independent evaluation of the facts.
Pretext interviews are barred with 'very narrow exceptions'.
Not stated here
The exceptions to the pretext interview limit are not described.
'Pretext interview' is not defined.
Legal Rights & Agreement Rules · Company commitment
Covered mastectomy includes reconstruction and related benefits under the federal Women's Health and Cancer Rights Act
A mastectomy that is covered by the member’s health plan includes benefits that comply with the Women’s Health and Cancer Rights Act of 1998. These are reconstruction of the breast(s) 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. The notice points to the U.S. Department of Labor website for more information about the Act.
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.
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.
Qualifications & exceptions
Applies when the mastectomy is covered by the plan.
Not stated here
The Act's text is not supplied.
Legal Rights & Agreement Rules · Company commitment
Insurer says it follows federal civil rights laws and offers free aids and language help
The notice says the insurer follows federal civil rights laws in its health programs and activities and does not discriminate, exclude people, or treat them differently based on race, color, national origin, sex, age, or disability. For people with disabilities it offers free aids and services. For people whose main language is not English it offers free help through interpreters and other written languages. Members are told to call the Member Services number on the ID card for help (TTY/TDD: 711).
Supporting quotations
It’s important we treat you fairly
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).
Qualifications & exceptions
Applies to the insurer's health programs and activities.
Not stated here
The specific aids, services and languages are not listed.
Legal Rights & Agreement Rules · Procedure
How to file a discrimination complaint
A member who thinks the insurer 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 the address given, file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at its address, call 1-800-368-1019 (TDD: 1-800-537-7697), or go online to the HHS portal and 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.
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 listed routes are the Compliance Coordinator and the HHS Office for Civil Rights; the telephone and online routes appear to be HHS routes.
Not stated here
No deadline for a complaint is stated.
The second web address contains a stray space in the stored text ('https://www. hhs.gov'), which may be a PDF extraction artifact.
Legal Rights & Agreement Rules · Context
Coverage is provided by WellPoint Life & Health Insurance Company
The last line states that coverage is provided by WellPoint Life & Health Insurance Company. This is the only company named in the stored text. The notice never defines ’we’, so it is not stated whether ’we’ throughout the notice means this entity, its affiliates, or the wider Wellpoint organization.
Supporting quotations
Coverage is provided by WellPoint Life & Health Insurance Company.
Qualifications & exceptions
Stated as the provider of coverage, not as a definition of 'we'.
Not stated here
Whether 'we' means this company alone is not stated.