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.
Account & Service Control · User right or choice
Members can sign up to receive these notices by email
The notice invites members who want to go paperless to go to the Wellpoint website and sign up to get these notices by email, and to read them online or on the mobile app. It is offered as an option; the text does not say how paper delivery changes after sign-up.
Supporting quotations
Would you like to go paperless and read this online or on your mobile app? Go to www.wellpoint.com and sign up to get these notices by email.
Qualifications & exceptions
Phrased as an invitation ('Would you like to go paperless'), not a requirement.
Not stated here
Whether signing up requires an online account, and whether paper copies stop, is not stated.
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.
Data Access & Collection · Context
What the notice means by personal information (PI)
The state section describes the member’s nonpublic (private) personal information, or PI, as information that identifies the member and is often gathered in an insurance matter. It says the insurer may collect, use, and share PI as described in the notice, and that the insurer’s goal is to protect PI because it can be used to make judgments about the member’s health, finances, character, habits, hobbies, reputation, career, and credit. PI is the state-law term here; the HIPAA section later uses a different term, protected health information (PHI), and the notice does not explain how the two overlap.
Supporting quotations
Your nonpublic (private) personal information (PI) identifies you, and it’s often gathered in an insurance matter.
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
The definition is general ('identifies you', 'often gathered in an insurance matter'); no list of data types is given.
Not stated here
Which specific data counts as PI, beyond the general description, is not listed.
How PI relates to PHI in the HIPAA section is not stated.
Account & Service Control · User right or choice
Right to see and correct your PI
In the state section the member is told they have the right to see and correct their PI. This sentence does not describe how to make a request, how long it takes, or any limits. The HIPAA ’Your rights’ section describes written requests for PHI, but it does not say that process also governs PI.
Supporting quotations
You have the right to see and correct your PI.
Qualifications & exceptions
Stated without conditions in this sentence; no process or deadline is given here.
Not stated here
How to exercise this PI right, and any limits on it, are not stated in the state section.
Data Access & Collection · Company practice
PI may be received from doctors, hospitals and other insurers
The notice says the insurer may receive a member’s PI from others, such as doctors, hospitals, or other insurance companies. The examples are illustrative (’such as’), so other sources are not excluded by this sentence.
Supporting quotations
We may receive your PI from others, such as doctors, hospitals, or other insurance companies.
Qualifications & exceptions
'Such as' makes the list of sources non-exhaustive.
Not stated here
Other sources of PI, and what PI is received from each, are not stated.
Sharing & Disclosure · Company practice
PI may be shared outside the company, sometimes without approval, with opt-outs only for some activities
The notice says the insurer may share a member’s PI with others outside the company, ’without your approval, in some cases’. It adds that it takes reasonable measures to protect the information. Where an activity requires the insurer to give the member a chance to opt out, the insurer says it will tell the member and explain how to say they do not want their PI used or shared for that activity. The text does not say which activities allow an opt-out, so the opt-out applies only to activities where such a chance is required.
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.
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
'In some cases' limits the no-approval sharing but does not say which cases.
Opt-out is described only for activities that 'require' giving the member that chance.
Not stated here
Who the outside recipients are, which cases need no approval, and which activities carry an opt-out are not specified in this paragraph.
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.
Use & Processing · Company practice
PHI may be collected, used and shared for payment and healthcare operations
The notice says there are times the insurer may collect, use, and share protected health information (PHI) as allowed or required by law, including the HIPAA privacy rule. For payment, it does so to take care of the member’s account and benefits, or to pay claims for healthcare the member gets through the plan. It also does so for its healthcare operations. ’Healthcare operations’ is not defined in this notice; the examples that follow only partly show what it covers. Members have rights, set out under ’Your rights’, to ask that PHI not be used for treatment, payment, or healthcare operations and to ask for a restriction on PHI for services paid out of pocket, but the insurer may say no to the first request.
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.
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.
Healthcare operations: We collect, use, and share PHI for our healthcare operations.
Qualifications & exceptions
The permission is 'as allowed or required by law, including the HIPAA privacy rule'.
'Healthcare operations' is stated without a definition or list.
The member's rights to ask for limits on these uses are in the 'Your rights' section; the insurer may refuse some requests.
Not stated here
What the insurer counts as 'healthcare operations' is not defined here.
Sharing & Disclosure · Company practice
Insurer does not provide treatment but uses and shares treatment information
For treatment activities, the notice says the insurer does not provide treatment, but collects, uses, and shares information about the member’s treatment to offer services that may help the member, including sharing information with others 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
Stated purpose is 'to offer services that may help you'.
Not stated here
Which services are offered and which treatment providers receive the information are not specified.
Use & Processing · Company practice
Examples of routine uses of member information
Under ’Examples of ways we use your information’, the notice lists that the insurer keeps information on file about premium and deductible payments, may use PHI to review the quality of care and services the member gets, and may use PHI to help with services for conditions like asthma, diabetes, or traumatic injury. These are introduced as examples, not as the full list of uses.
Supporting quotations
Examples of ways we use your information:
We keep information on file about your premium and deductible payments.
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
Introduced as examples; the list is not stated to be complete.
Not stated here
How the services for conditions such as asthma or diabetes are delivered or chosen is not described.
Sharing & Disclosure · Company practice
Examples of routine sharing with doctors, hospitals and the plan subscriber
The notice’s examples of sharing include giving information to a doctor’s office to confirm benefits, sharing the explanation of benefits (EOB) with the subscriber of the plan for payment purposes, and sharing PHI with the member’s doctor or hospital so they may treat the member. The EOB example names the subscriber, who may be a different person from the member; the notice does not define ’subscriber’ or say what an EOB contains.
Supporting quotations
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.
We may share PHI with your doctor or hospital so that they may treat you.
Qualifications & exceptions
Presented as examples under the heading of ways information is used.
Not stated here
Who the subscriber is relative to the member is not defined, and the notice does not say what an EOB contains.
Data Access & Collection · Company practice
Insurer may collect and use public or commercially available data about members
One example says the insurer 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. The stated purpose limits the use to supporting the member and helping the member get plan benefits and services; the notice does not say where the data comes from, what kinds of data it covers, or whether it is combined with PHI.
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.
Qualifications & exceptions
Stated purpose: 'to support you and help you get health plan benefits and services'.
Not stated here
The sources, data types and any combination of this data with PHI are not described.
Use & Processing · Company practice
PHI may be used with technology to support services
Another example says the insurer may use PHI with technology to support and enable services provided to the member. The sentence is general: it does not say what technology is used, who runs it, or whether it makes decisions about the member.
Supporting quotations
We may use PHI with technology to support and enable services provided to you.
Qualifications & exceptions
Stated only in general terms.
Not stated here
The type of technology, who operates it, and whether it is automated decision-making are not stated.
Use & Processing · Company practice
PHI may be used to create, use or share de-identified data
The insurer says it may use a member’s PHI to create, use, or share de-identified data as allowed by HIPAA. The notice does not say what the de-identified data is used for or who receives it.
Supporting quotations
We may use your PHI to create, use, or share de-identified data as allowed by HIPAA.
Qualifications & exceptions
Limited to what HIPAA allows.
Not stated here
Purposes and recipients of the de-identified data are not stated.
Sharing & Disclosure · Company practice
PHI may be shared with health information exchanges; the notice points to the website for opting out
The insurer says it may use and share PHI directly or indirectly with health information exchanges for payment, healthcare operations, and treatment. For members who do not want their PHI shared in these situations, the notice says to visit www.wellpoint.com/privacy for more information. The notice itself does not say whether the member can opt out or how; it only points to the website, which is not part of the supplied text.
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.wellpoint.com/privacy for more information.
Qualifications & exceptions
Sharing is for payment, healthcare operations and treatment, 'directly or indirectly'.
Not stated here
Whether an opt-out exists, and its process, are not stated in this notice; the website page is not supplied.
Use & Processing · Company practice
Insurer must give access to your PHI and may contact you about benefits, other plans and reminders
Under ’Sharing your PHI with you’, the insurer says it must give the member access to their own PHI. It may also contact the member about treatment options or other health-related benefits and services, and may tell the member or their dependents about other plans or programs they may be eligible for, including individual coverage, when they reach a certain age. It may send reminders about routine medical checkups and tests, and the member may get emails with limited PHI, such as welcome materials. The notice says it will ask the member’s permission before contacting them. The scope of that permission is not explained: it does not say which of these contacts it covers. A later section separately says the insurer may call or text using an automatic dialer.
Supporting quotations
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.
Qualifications & exceptions
The permission sentence is general and not tied to a particular type of contact.
'A certain age' is not stated.
Not stated here
Which contacts require the member's permission, and what age triggers the plan notices, are not stated.
Sharing & Disclosure · Company commitment
Written permission is needed for most other uses, marketing, sale of PHI and psychotherapy notes
The notice says that in most cases, if the insurer uses or shares PHI outside of treatment, payment, operations, or research activities, it has to get the member’s written okay first. It must also get written permission before using PHI for certain marketing activities, selling PHI, or sharing psychotherapy notes from the member’s doctor or therapist, and it may need written permission in other situations not listed. The member can cancel any written permission at any time; the later Authorization section adds that cancellation must be in writing and does not undo actions already taken. Research is named among the activities that do not need that written okay. Separate paragraphs allow sharing for public health, legal and government reasons; the notice does not say how the written-permission rule applies to those.
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.
Using your PHI for certain marketing activities.
Selling your PHI.
Sharing any psychotherapy notes from your doctor or therapist.
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.
Qualifications & exceptions
'In most cases' means there are cases without a written okay.
The marketing rule applies to 'certain' marketing activities only.
Treatment, payment, operations and research are outside the written-permission rule.
Not stated here
Which marketing activities count as 'certain', and which other situations need written permission, are not listed.
Sharing & Disclosure · User right or choice
Member can tell the insurer to share information with family, friends or in emergencies
The notice says the member has the right and choice to tell the insurer 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. It does not say how the member tells the insurer or whether this must be in writing.
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
Framed as a choice to tell the insurer to share; the notice does not describe a choice to refuse in these terms.
Not stated here
How the choice is made, and whether writing is required, are not stated.
Sharing & Disclosure · Restriction or exception
Insurer may share PHI when you cannot state a preference or there is a serious threat
If the member cannot state a preference, for example in an emergency or if unconscious, the insurer says it may share PHI if it believes this is in the member’s best interest. It may also share information when needed to lessen a serious and likely threat to health or safety. This operates as an exception to the choices above: the insurer applies its own belief about the member’s best interest, and the sentence does not name the recipients.
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. We may also share your information when needed to lessen a serious and likely threat to your health or safety.
Qualifications & exceptions
Depends on the insurer's belief about the member's best interest.
PHI may be shared for public health and safety purposes
In a list of other reasons to use or share information, the notice says the insurer is allowed, and in some cases required, to share information in other ways, usually for the good of the public. For public health and safety, it names 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. The list is introduced as ’these 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.
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
'Usually for the good of the public' and the 'such as' wording leave room for sharing beyond the examples under the public health heading.
The written-permission paragraph does not list these purposes as exempt, and this paragraph does not say whether written permission is needed for them.
Not stated here
Who receives the information and what conditions apply for each purpose are not stated.
Whether written permission is required for these purposes is not stated either way.
Sharing & Disclosure · Permission or license
PHI may be shared for health research and with organ donation groups
The notice lists doing health research and responding to organ donation groups for research and certain reasons among the purposes for which the insurer may use or share information. The earlier written-permission paragraph names research as an activity outside the written-permission rule, so research uses do not need the member’s written okay. The notice does not say what conditions apply to research sharing or whether the information is identifiable.
Supporting quotations
Doing health research.
Responding to organ donation groups for research and certain reasons.
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
Organ donation sharing is for 'research and certain reasons', and the 'certain reasons' are not listed.
Not stated here
Conditions for research sharing, and whether data is identified, are not stated.
PHI may be shared to obey the law, for lawsuits, government requests and law enforcement
Among the reasons for sharing information, the notice lists obeying the law if it requires sharing, addressing workers’ compensation, law enforcement and other government requests, alerting proper authorities if the insurer believes the member may be a victim of abuse or other crimes, responding to lawsuits and legal actions, and responding to the federal Secretary of Health and Human Services for HIPAA compliance and enforcement purposes. The wording ’other government requests’ is open-ended, and the notice does not say what legal process the insurer requires.
Supporting quotations
Obeying the law, if it requires sharing your information.
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.
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 it requires sharing'.
Alerting authorities depends on the insurer's belief that the member may be a victim.
Not stated here
What legal process is required, and what scope of information is shared for each request, is not stated.
Sharing & Disclosure · Permission or license
For employer-based coverage, PHI may be shared with the group health plan; employer access is limited
If the member is enrolled through an employer, the insurer says it 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 PHI for permitted reasons and is required by law to protect it. The notice does not say what applies when the employer does pay claims, and it does not define the permitted reasons. The stored text does not mention retiree coverage, so how this applies to retirees is not stated.
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
The employer limit is stated for an employer that pays premium but not claims.
Not stated here
What happens when the employer pays claims, and what the 'permitted reasons' are, are not stated.
Retiree coverage is not mentioned in the text.
Use & Processing · Company commitment
Written permission is needed for purposes not in the notice and can be cancelled in writing, but not retroactively
The Authorization section says the insurer will get the member’s written permission before using or sharing PHI for any purpose not stated in the notice. The member may cancel that permission at any time, in writing, and the insurer then stops using PHI for that purpose. If the insurer has already used or shared PHI with the member’s permission, it cannot undo what it did before the member told it to stop. This qualifies the earlier statement that the member can cancel written permission at any time: the cancellation must be in writing and takes effect going forward only.
Supporting quotations
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.
Qualifications & exceptions
Cancellation must be in writing.
Cancellation does not reverse uses or sharing that already happened with the permission.
Not stated here
Where to send a cancellation, and how long the insurer takes to stop, are not stated here.
Genetic information cannot be used to decide coverage or its price
The notice says the insurer cannot use the member’s genetic information to decide whether it will give coverage or to decide the price of that coverage. The limit is stated for coverage decisions and pricing only; the notice does not say what other uses of genetic information are allowed or barred.
Supporting quotations
We cannot use your genetic information to decide whether we’ll give you coverage or decide the price of that coverage.
Qualifications & exceptions
Limited to deciding whether to give coverage and the price of coverage.
Not stated here
Other uses of genetic information are not addressed.
Inference & Profiling · Company practice
Insurer may collect, infer and use race, ethnicity, language, sexual orientation and gender identity information
The notice says the insurer may collect, infer, receive, and/or maintain race, ethnicity, language, sexual orientation, and gender identity information about the member and protects it as described in the notice. It may use this information to help the member, including identifying specific needs, developing programs and educational materials, and offering interpretation services. The notice also says the insurer does not use this information to decide whether it will give coverage, what kind of coverage, or the price of coverage, and does not share it with unauthorized persons. ’Infer’ means some of this information may be drawn by the insurer rather than provided by the member; the notice does not say how.
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.
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.
Qualifications & exceptions
Uses listed are 'including', so not exhaustive.
The barred uses are coverage decisions, kind of coverage and price.
Sharing is barred only with 'unauthorized persons'.
Not stated here
How the information is inferred, and who counts as an 'authorized' recipient, are not stated.
Account & Service Control · User right or choice
Right to a copy of your PHI on written request, including by unencrypted email
Under federal law the member can send a written request to see or get a copy of their PHI, including a copy by email. The notice warns that PHI sent by regular, unencrypted email could be read by a third party, so the insurer first confirms the member wants it by unencrypted email. It says the insurer usually provides a copy within 30 days of the request and will tell the member if it needs more time.
Supporting quotations
Under federal law, you have the right to:
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 written.
'Usually' within 30 days; more time is possible with notice.
Not stated here
The length of any extension is not stated.
Account & Service Control · User right or choice
Right to ask for correction of PHI you believe is wrong or incomplete
The member can ask the insurer to correct PHI they believe is wrong or incomplete. If someone else, such as the member’s doctor, gave the insurer the PHI, the insurer will tell the member so they can ask that source to correct it. The insurer 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 insurer may refuse, with a written reason within 60 days.
For PHI supplied by another source, the member is directed to ask that source.
Not stated here
The notice does not say whether the member can contest a refusal or add a statement under HIPAA; a rebuttal right appears only in the Maine section.
Use & Processing · User right or choice
Right to ask that PHI not be used for treatment, payment or operations; the insurer may refuse
The member can send a written request that the insurer not use their PHI for treatment, payment, or healthcare operations activities. The insurer may say no, but will explain why in writing. The notice gives no timeframe for the written explanation here.
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
The request must be written; the insurer may refuse.
Not stated here
Grounds for refusal and the time for a written reason are not stated.
Cross-references
qualifies (model-proposed): PHI may be collected, used and shared for payment and healthcare operations — qualifies: The member may send a written request not to have PHI used for treatment, payment, or healthcare operations; the insurer may refuse, so the payment and operations permission is limited only if the insurer agrees.
Account & Service Control · User right or choice
Right to request confidential communications
The member can ask the insurer to send PHI or contact them in other reasonable ways. The member can also ask that mail go to a different address if sending it to the home could put them 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
Limited to ways that are 'reasonable'.
Not stated here
Whether a request must be in writing, and what the insurer considers reasonable, are not stated.
Sharing & Disclosure · User right or choice
Right to a list of those with whom your PHI was shared
The member can send a written request for a list of those with whom the insurer has shared their PHI. The insurer says it will usually provide the list within 60 days and 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 request must be written; 'usually' within 60 days.
Not stated here
Which disclosures appear on the list, and any time period it covers, are not stated.
Use & Processing · User right or choice
Right to ask for a restriction on PHI for services you pay for in full yourself
If the member pays in full out of pocket for any medical services, they have the right to ask for a restriction that would prevent the use or sharing of that PHI for treatment, payment, or operations reasons. The notice then says that if the member or their provider submits a claim to the insurer, it may not agree to a restriction, and that if a law requires sharing the information, the insurer does not have to agree. So the right is to ask; it does not promise the restriction is granted. The notice refers to ’Your rights’ above for this limit but does not identify which earlier item is meant, so the cross-reference is unclear.
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
Applies to services paid in full out of pocket.
The insurer may not agree if a claim is submitted by the member or provider.
The insurer need not agree where a law requires sharing.
Not stated here
Which 'Your rights' item the parenthetical refers to is unclear, since the sentence is itself in that list.
The notice does not say how the member makes the request.
Account & Service Control · Procedure
Call Member Services to use these rights
To use any of these rights, the member is told to call Member Services at the phone number on the ID card. A representative can give the address for sending a request and any forms that may help. Several rights above require a written request, so the call is how the member gets the address and forms; the notice does not say whether a call alone is enough.
Supporting quotations
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.
Not stated here
Whether a phone request alone is sufficient for any right is not stated.
Security & Safeguards · Company commitment
Safeguards the insurer says it uses to protect PHI
The insurer says it is dedicated to protecting PHI and has set up policies and information practices to keep it secure and private. It says it keeps oral, written, and electronic PHI safe through procedures and physical and electronic means that follow federal and state laws, such as securing offices that hold PHI, password-protecting computers, and locking storage areas and filing cabinets. Employees must protect PHI under written policies that limit access to those who need the data for their jobs, and wear ID badges to keep unauthorized people out of areas where PHI is kept.
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.
We keep your oral, written, and electronic PHI safe using the right procedures, and through physical and electronic ways.
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.
These policies limit access to PHI to only those employees who need the data to do their jobs.
Qualifications & exceptions
The measures are examples ('Some of the ways').
Not stated here
No specific technical standards, such as encryption, are described.
Security & Safeguards · Company commitment
Insurer must tell you if it believes your PHI has been breached
The notice says that if the insurer believes the member’s PHI has been breached, it must let the member know. No deadline, method, or content of the notice is given here.
Supporting quotations
If we believe your PHI has been breached, we must let you know.
Qualifications & exceptions
Triggered by the insurer's belief that a breach occurred.
Not stated here
Timing and form of breach notices are not stated.
Sharing & Disclosure · Company commitment
Business partners must protect PHI and cannot pass it on without written permission, unless the law allows
The notice says that, where required by law, the insurer’s business partners must protect the privacy of data it shares with them. It says they are not allowed to give the member’s PHI to others without written permission, unless the law allows it and it is stated in the notice. The business partners are not named or described.
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
'Where required by law' limits the duty to protect.
Onward sharing is barred except where the law allows and the notice states it.
Not stated here
Who the business partners are and what data they receive are not stated.
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.
Use & Processing · Company practice
Insurer, affiliates and vendors may call or text using an automatic dialer or artificial voice
The notice says the insurer, including its affiliates and/or vendors, may call or text the member using an automatic telephone dialing system and/or an artificial voice, but only in accordance with the Telephone Consumer Protection Act (TCPA). The calls may be about treatment options or other health-related benefits and services. The earlier contact paragraph says the insurer will ask the member’s permission before contacting them, and this section does not say whether the TCPA-related permission is the same permission; the two statements are not reconciled in the text.
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
Stated to be only in accordance with the TCPA; the TCPA is not supplied.
The topics named are treatment options and health-related benefits and services; 'may be about' is not exhaustive.
Not stated here
Whether consent is obtained before autodialed calls or texts is not stated.
Who the affiliates and vendors are is not stated.
Cross-references
contrast (model-proposed): Insurer must give access to your PHI and may contact you about benefits, other plans and reminders — contrast: One paragraph says the insurer will ask the member's permission before contacting them; a later section says the insurer may call or text by automatic dialer in accordance with the TCPA. The text does not reconcile the two, so the extent of the permission is unclear.
Use & Processing · User right or choice
Tell the caller or call the Do Not Call number to stop calls and texts
If the member does not want to be contacted by phone, they can tell the caller or call 1-844-203-3796 to add their phone number to the insurer’s Do Not Call list. The insurer 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.
Qualifications & exceptions
Described as covering phone calls and texts to the member.
Not stated here
How quickly the insurer stops contacting the member is not stated.
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.
Account & Service Control · Procedure
Contact Member Services for help with rights, complaints and privacy questions
The notice says the member may call the Member Services phone number on their ID card. Its representatives can help the member apply their rights, file a complaint, or talk about privacy issues. No separate privacy office or address is named.
Supporting quotations
You may call us at the Member Services phone number on your ID card.
Qualifications & exceptions
The only contact channel named is the Member Services phone number on the ID card.
Not stated here
No other contact channel, such as an email or mailing address, is given in this section.
Account & Service Control · User right or choice
Right to a new copy of the notice, including on paper
The member has the right to get a new copy of this notice at any time. Even if the member has agreed to get the notice electronically, they still have 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.
Qualifications & exceptions
Applies at any time and regardless of electronic delivery agreement.
Not stated here
How to request a copy is not described in this paragraph.
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.
Account & Service Control · User right or choice
Maine residents have additional rights to access, correct and add a statement to their personal information
For Maine residents, the notice says the Maine Insurance Information and Privacy Protection Act gives additional rights: to obtain access to the consumer’s recorded personal information in the possession or control of a regulated insurance entity, to request correction if the consumer believes it is inaccurate, and to add a rebuttal statement to the file if there is a dispute. These rights are listed only for Maine residents. The earlier state section says other states may give additional rights, but no other state’s rights are described.
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.
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.
The right to:
Qualifications & exceptions
Applies to consumers in Maine.
Not stated here
How a Maine resident makes these requests, and whether the rights reach this plan, is not described.
Whether other states grant similar rights is not stated; the absence of other states in this notice is not proof of none.
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.
Charges & Financial Obligations · Restriction or exception
Usual deductible, copay or coinsurance still applies; ask the plan administrator for details
The notice says the member will pay their usual deductible, copay, and/or coinsurance for these benefits and should contact their plan administrator for details. It does not give amounts.
Supporting quotations
You’ll pay your usual deductible, copay, and/or coinsurance. For details, contact your plan administrator.
Qualifications & exceptions
Cost sharing is the member's usual deductible, copay and/or coinsurance.
Not stated here
Amounts are not stated, and the plan administrator is not named.
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.
Account & Service Control · User right or choice
Right to this information in your language for free and in other formats
The member has the right to get this information in their language for free. For extra help in another language, the member can call the Member Services number on the ID card (TTY/TDD: 711). The insurer also offers the notice in a different format for members with visual impairments, available by calling the same number.
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).
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.
Qualifications & exceptions
The format offer is described for members with visual impairments.
Not stated here
Which languages and formats are available is not listed.
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.