Group Medicare Notice of Privacy Practices for Anthem Blue Cross and Blue Shield (Group Retiree Solutions)

Elevance Health / Anthem · Official agreement

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Legal Rights & Agreement Rules · Context

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.

Details
Who
The company (Anthem Blue Cross and Blue Shield) sending the notice to members
When
Each year
What it covers
Three combined notices: state privacy practices, HIPAA privacy practices, 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.

Details
What it does
Sign up at the Anthem website to receive these notices by email

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.

Details
What it covers
Health information handled under relevant state laws
Condition
Benefits covered: health, dental, vision and life insurance the 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.

Details
What it does
Call Member Services to learn about additional state limits on sharing
Where
Member's state, as it may provide additional rights

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.

Details
What it covers
Nonpublic personal information (PI) that identifies the member
What it does
See and correct your 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.
Also annotated in the same passage (1)

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.

Details
Who
The company
What it does
Collect, use and share
What it covers
Member personal information (PI)
Why
Protecting information that could be used to make judgments about the member

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.
Also annotated in the same passage (1)

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.

Details
What it does
Receive PI from others
Who
Doctors, hospitals, other insurance companies (examples)

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.
Also annotated in the same passage (2)

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.

Details
What it does
Share PI with others outside the company
Condition
In some cases, without the member's approval

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.

Cross-references

Also annotated in the same passage (1)

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.

Details
Condition
An activity requires giving the member a chance to opt out
What it does
Tell the member, and explain how to opt out

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

Also annotated in the same passage (1)

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.

Details
What it covers
Medical, vision and dental information
What it does
Use and disclose it, and give access to it

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.

Details
Who
The company
What it covers
Health and financial information of current and former members
Why
Privacy as required by law, accreditation standards and internal rules

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.

Details
What it covers
Protected Health Information (PHI)
Condition
As allowed or required by law, including the HIPAA privacy rule

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.

Details
What it does
Collect, use and share PHI
Why
Take care of the account and benefits, or pay claims for healthcare received 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.

Details
What it does
Collect, use and share PHI
Why
The company's 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.

Details
What it does
Collect, use and share information about treatment
Why
Offer services that may help the member, including sharing with those providing 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.

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.

Details
What it does
Keep payment records; give information to a doctor's office; share EOB with the subscriber
Why
Confirm benefits; payment

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.

Details
What it does
Share PHI
Who
The member's doctor or hospital
Why
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.

Details
What it does
Use PHI
Why
Review quality of care and services; help with services for certain conditions

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.

Details
What it does
Collect and use
What it covers
Publicly and/or commercially available data about the member
Why
Support the member and help them 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.

Details
What it does
Use PHI with technology
Why
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.

Details
What it does
Create, use or share de-identified data
Condition
As allowed by HIPAA

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.

Details
What it does
Use and share PHI directly or indirectly
Who
Health information exchanges
Why
Payment, healthcare operations, treatment

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.

Details
What it does
Give access
What it covers
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.
Also annotated in the same passage (2)

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.

Details
What it does
Contact the member; tell them about other plans; send reminders and emails
Why
Treatment options, health-related benefits and services, other plans or programs, routine checkups and tests

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.
Also annotated in the same passage (2)

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.

Details
What it does
Ask permission before contacting the member

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

Also annotated in the same passage (2)

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.

Details
Condition
Use or sharing outside treatment, payment, operations or research
What it does
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.

Cross-references

Also annotated in the same passage (1)

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.

Details
What it does
Get written permission before marketing use, selling PHI, or sharing psychotherapy notes

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.
Also annotated in the same passage (1)

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.

Details
What it does
Cancel written permission 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.

Details
What it does
Tell the company to share information
Who
Family, close friends or others involved with treatment or payment

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.

Details
Condition
The member cannot state a preference, for example in an emergency or if unconscious
What it does
Share PHI

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.

Cross-references

Also annotated in the same passage (1)

Sharing & Disclosure · Permission or license

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.

Details
Condition
Needed to lessen a serious and likely threat to health or safety
What it does
Share information

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.
Also annotated in the same passage (1)

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.

Details
What it does
Share information
Why
Public good, such as public health and research

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.

Cross-references

Sharing & Disclosure · Permission or license

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.

Details
Why
Public health and safety issues
What it does
Share information, including making reports

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.

Details
Why
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.

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.

Details
Who
Organ donation groups
Why
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.

Details
Why
Workers' compensation, law enforcement, other government requests, alerting authorities

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.

Details
Condition
Enrolled through an employer
What it does
Share PHI with the group health plan
Exception
Employer paying premium but not claims may only have PHI for permitted reasons

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.

Details
Condition
Any purpose not stated in the notice
What it does
Get written permission before using or sharing PHI

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.
Also annotated in the same passage (1)

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.

Details
What it does
Cancel permission in writing; the company stops using PHI for that purpose
Exception
Actions already taken with permission cannot be undone

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.
Also annotated in the same passage (1)

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.

Details
What it covers
Genetic information
Why
Not to be used to decide coverage or its price

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.

Details
What it does
Collect, infer, receive and/or maintain; use to help the member
What it covers
Race, ethnicity, language, sexual orientation and gender identity information
Why
Identify specific needs, develop programs and educational materials, offer 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.
Also annotated in the same passage (1)

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.

Details
What it does
Do not use for coverage decisions; do not share 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.
Also annotated in the same passage (1)

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.

Details
What it does
Call Member Services to use these rights and get the address and forms

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.

Details
What it does
Request to see or get a copy of PHI
When
Usually within 30 days
Condition
Company confirms the member wants unencrypted email before sending

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.

Details
What it does
Ask the company to correct PHI
When
Written reason for a refusal 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.

Details
What it does
Ask in writing that PHI not be used for treatment, payment or healthcare operations

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.

Cross-references

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.

Details
What it does
Ask the company to use other reasonable ways or addresses

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.

Details
What it does
Request a list of those with whom PHI was shared
When
Usually within 60 days

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.

Details
Condition
Member pays in full out of pocket
Exception
Claim submitted by member or provider; or law requires sharing
What it does
Ask for a restriction on use or sharing for treatment, payment or operations

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.

Cross-references

Security & Safeguards · Company commitment

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.

Details
What it does
Maintain policies and information practices; notify the member of a believed breach

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.

Details
What it does
Secure offices, password-protect computers, lock storage; limit employee access; require ID badges
What it covers
Oral, written and electronic PHI

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.
Also annotated in the same passage (1)

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.

Details
Who
The company's business partners
Exception
Unless the law allows it and the notice states it

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.
Also annotated in the same passage (1)

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.

Details
Condition
A state or federal privacy law requires more privacy protection
What it does
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.

Cross-references

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.

Details
What it covers
Substance Use Disorder information received from providers or programs regulated by 42 CFR Part 2
What it does
Disclose only in compliance with applicable law; allowed for certain treatment, payment and operations; member can consent and revoke in writing

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.

Cross-references

Legal Rights & Agreement Rules · Procedure

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.

Details
What it does
Visit the Privacy web page

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.

Details
Who
The company, its affiliates and/or vendors
What it does
Call or text using an automatic dialing system and/or artificial voice
Why
Treatment options or other health-related benefits and services
Condition
In accordance with the TCPA

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.

Cross-references

  • contrast (model-proposed): The paragraph ends: we will ask your permission before we contact you — 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.
Also annotated in the same passage (1)

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.

Details
What it does
Tell the caller or call 1-844-203-3796 to join the Do Not Call list

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.
Also annotated in the same passage (1)

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.

Details
What it does
File a privacy complaint with the company or with the HHS Office for Civil Rights

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/.
Also annotated in the same passage (1)

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.

Details
What it does
Will not take action against the member for filing a 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".
Also annotated in the same passage (1)

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.

Details
What it does
Call Member Services

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.

Details
What it does
Get a new copy of the notice, including 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.
Also annotated in the same passage (2)

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.

Details
What it does
Change the notice; apply a revised notice to existing and future PHI
When
Notice in effect at this time must be followed

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.
Also annotated in the same passage (2)

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.

Details
What it does
Tell members about changes through a newsletter, the 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.
Also annotated in the same passage (2)

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.

Details
When
Original effective date April 14, 2003; most recent revision in the footer

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

  • refers to (model-proposed): A footer line reads Effective May 2025 — 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.

Details
Where
Maine

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.

Details
Where
Maine
What it does
Access, request correction, add a rebuttal statement

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.

Details
Where
Maine
What it does
Know the reasons for an adverse underwriting decision

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.

Details
Where
Maine

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.

Details
Condition
A mastectomy covered by the health plan
What it covers
Breast reconstruction, symmetry surgery, prostheses and complication coverage

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.

Details
What it does
Pay the usual deductible, copay and/or coinsurance

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.

Details
What it does
Go to the 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.

Details
What it covers
Health programs and activities
What it does
Does not discriminate, exclude or treat people differently

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.
Also annotated in the same passage (1)

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).

Details
What it does
Offer free aids, services, interpreters and other written languages

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).
Also annotated in the same passage (1)

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.

Details
What it does
File a complaint (grievance) by mail, by phone or online
Condition
The member thinks the company failed to offer services or discriminated

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).

Details
What it does
Get this information in the member's language for free; call Member Services for help

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.

Details
What it does
Offer the notice in a different format; call Member Services to ask

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.

Details
Where
Colorado, Connecticut, Indiana, Georgia, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York (17 southeastern counties), Ohio, Virginia, Wisconsin
Who
The listed state entities that use the Anthem Blue Cross and Blue Shield name

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.
Also annotated in the same passage (2)

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.

Details
What it does
Underwrite or administer benefits, depending on the state and product
Where
Colorado, Missouri, New Hampshire, Wisconsin

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.
Also annotated in the same passage (2)

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.

Details
Who
Independent licensees of the Blue Cross and Blue Shield Association

Supporting quotations

Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
Also annotated in the same passage (2)