NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION

• THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
• HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
• YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
• HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION
• YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH THE PRIVACY OFFICER at (866) 403-2785 and HIPAA@AlliantPlans.com IF YOU HAVE ANY QUESTIONS.

PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices describes the practices of Health One Alliance LLC, its subsidiaries, or affiliates (collectively referred to herein as “Health One Alliance, LLC”) for safeguarding individually identifiable protected health information. The terms of this Notice apply to members and dependents for their individual and group health insurance.

We are required by law to maintain the privacy of Our members’ and dependents’ protected health information, provide notice of Our legal duties and privacy practices with respect to protected health information and notify affected individuals of a breach of their unsecured identifiable protected health information. We are required to abide by the terms of this Notice if it remains in effect.

Effective Date. This Notice of Privacy Practices is effective as of: 1/1/2025

Changes to the Terms of this Notice. We reserve the right to change the terms of this Notice as necessary, and the changes will apply to all protected health information that We have about You. The new notice will be available on Our Web site, and We will mail a copy to You upon request.

Uses and Disclosures of Your Protected Health Information, Authorization. Except as explained below, We will not use or disclose Your protected health information for any purpose unless You have signed a form authorizing Our use or disclosure. For example, authorization must be obtained before any uses and disclosures of Your protected health information by Us for marketing purposes, sale of protected health information, as well as most uses and disclosures of psychotherapy notes. Unless We have taken any action in reliance on the authorization, You have the right to revoke an authorization if the request for revocation is in writing and sent to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to revoke an authorization can be obtained from the Health Information Privacy Officer. For Substance Use Disorder records, as described below, you may provide a single consent for all future uses or disclosures for treatment, payment, and healthcare operations.   If the state law and federal law, including the laws that protect substance use disorder records conflict, we will comply with the more stringent law that provides greater privacy protection for you.

Uses and Disclosures for Treatment. We may disclose Your protected health information as necessary for Your treatment. For instance, a doctor or healthcare facility involved in Your care may request Your protected health information in Our possession to assist in Your care.

Uses and Disclosures for Payment. We use and disclose Your protected health information as necessary for payment purposes. For instance, We may use Your protected health information to process or pay claims, for subrogation, to perform a hospital admission review to determine whether services are for medically necessary care or to perform prospective reviews. We may also disclose information to another insurer to process or pay claims on Your behalf.

Uses and Disclosures for Healthcare Operations. We use and disclose Your protected health information as necessary for healthcare operations. For instance, We may use or disclose Your protected health information for quality assessment and quality improvement, credentialing healthcare providers, premium rating, conducting, or arranging for medical review or compliance. We may also disclose Your protected health information to another insurer, healthcare facility or healthcare provider for activities such as quality assurance or case management. We may contact Your healthcare providers concerning prescription drug or treatment alternatives.

Genetic Information Non-discrimination Act. We are prohibited from using Your genetic information for underwriting purposes. Genetic information for purposes of underwriting means, with respect to any individual, information about (i) such individual’s genetic tests, (ii) the genetic tests of family members of such individual, and (iii) the manifestation of a disease or disorder in family members of such individual (i.e., family medical history). It also includes the collection of genetic information for clinical research purposes but excludes information about the sex or age of any individual.

Substance Use Disorder Records requested from us for legal proceedings or court orders shall not be used or disclosed in any civil, administrative, criminal, or legislative proceedings against the patient unless based on specific written consent or a court order. If there is a court order you have an opportunity to be heard by the court when required by law and any court order that authorizes the use or disclosure of your substance use disorder records must be accompanied by a subpoena or similar legal mandate compelling disclosure before the record is used or disclosed.

Reproductive Health Care Records. We will not use or disclose your protected health information for the following purposes:

(1) to conduct a criminal, civil, or administrative investigation into you for the mere act of seeking, obtaining, providing, or facilitating reproductive health care;
(2) To impose criminal, civil, or administrative liability on any person for the mere act of seeking, obtaining, providing, or facilitating reproductive health care.
(3) To identify you for any of the reasons identified above in subsection (1) and (2).

This prohibition applies where we, or others acting on our behalf, have reasonably determined that:
(1) The reproductive health care is lawful under the law of the state in which it was provided under the circumstances in which it was provided, for example, if a resident of one state traveled to another state to receive reproductive health care, such as an abortion, that is lawful in the state where such health care is provided; or
(2) The reproductive health care is protected, required, or authorized by Federal law, including the U.S. Constitution, regardless of the state in which such health care is provided, for example, if the use of the reproductive health care, such as contraception, is protected by the Constitution; or
(3) The reproductive health care was not provided by us, but we presume it was lawful. However, if we receive a request for your information, and we have actual knowledge that the reproductive health care was not lawful under the circumstances under which it was provided to you, this presumption does not apply, for example, if you tell us you received reproductive health care from an unlicensed person and we know that the specific reproductive health care must be provided by a licensed health care provider.

Example. We will not send your records to the district attorney that includes your records related to reproductive health care when requested unless the district attorney provides an attestation that the information and records will not be used for any criminal, civil or administrative investigation or to impose liability upon you.

If we receive a request for the release of your reproductive health records from a governmental agency, law enforcement officer or a judicial subpoena related to health oversight activities, judicial or administrative proceedings, law enforcement activities or to coroners and medical examiners, we will request an attestation from the requesting party that your information will not be used for one of the prohibited reasons described above.

Example. the department of public health sends a subpoena requesting a copy of your medical records that contains information about your reproductive healthcare, we will not release your records unless the department of public health attests in writing that the records will not be used to investigate you or impose any liability on you for seeking or receiving reproductive healthcare services.

Information Received Pre-enrollment. We may request and receive from You and Your healthcare providers Your protected health information prior to Your enrollment under the group health insurance policy. We will use this information to determine whether You are eligible to enroll under the policy and to determine the premium rates. If You do not enroll, We will not use or disclose the information We obtained about You for any other purpose. Information provided on enrollment forms or applications will be utilized for all coverages being applied for, some of which may be protected by the state, not federal, privacy laws.

Business Associates. Certain aspects and components of Our services are performed by third party persons or organizations pursuant to agreement or contract with us. It may be necessary for Us to disclose Your protected health information to these third-party persons or organizations that perform services on Our behalf. We require them to appropriately safeguard the privacy of Your protected health information as required by law.

Family, Friends, and Personal Representatives. With Your written authorization, We may disclose to family members, close personal friends, or another person You identify, Your protected health information relevant to their involvement with Your care or paying for Your care. If You have given someone medical power of attorney or if someone is Your legal guardian, that person can exercise Your rights and make choices about Your protected health information. We will make sure the person has the authority and can act for You before We take any action.

In Cases of Incapacity or Emergency. If You are unavailable, incapacitated or involved in an emergency, and We determine that a limited disclosure is in Your best interests, We may disclose Your protected health information to family members, close personal friends, or another person You have identified without Your approval. We may also disclose Your protected health information to public or private entities to assist in disaster relief efforts.

Communications Through Text Messages or Emails. With Your written authorization or consent, including Your voluntary acknowledgement that text and email messages are not secure and You are assuming the risk of unauthorized access or disclosure to a third-party, We may communicate to You via text messages or emails for purposes of payment, debt collection, healthcare operations and treatment, including appointment reminders, information about insurance program benefits, preventative health and wellness reminders, instructions and follow ups. The methods of contact may include but are not limited to prerecorded or artificial voice messages, automatic telephone dialing system, including auto-dialers, text messages, electronic chat, and/or email messages, as applicable.

Other Uses and Disclosures. We are permitted or required by law to use or disclose Your protected health information, without Your authorization, in the following circumstances:

• For any purpose required by law;
• For public health activities (for example, reporting of disease, injury, birth, death or suspicion of child abuse or neglect);
• To a governmental authority if We believe an individual is a victim of abuse, neglect, or domestic violence;
• For health oversight activities (for example, inspections, licensure actions or civil, administrative, or criminal proceedings or actions);
• For judicial or administrative proceedings (for example, pursuant to a court order, subpoena, or discovery request);
• For law enforcement purposes (for example, reporting wounds or injuries or for identifying suspects, witnesses, or missing people);
• To coroners and funeral directors;
• For procurement, banking or transplantation of organ, eye, or tissue donations;For certain research purposes;
• To avert a serious threat to health or safety under certain circumstances;
• For military activities if You are a member of the armed forces, for intelligence or national security issues; or about an inmate or an individual to a correctional institution or law enforcement official having custody; and
• For compliance with workers’ compensation insurance purposes.
• We will adhere to all applicable state and federal laws or regulations that provide additional privacy protections. We will only use or disclose AIDS/HIV-related information, genetic testing information and information pertaining to Your mental condition or any substance abuse problems as permitted by state and federal law or regulation. Except for the types of uses and disclosures of protected health information described in this Notice, We may make other uses and disclosures of protected health information only with Your written authorization.

Your Rights Regarding the Restriction on Use and Disclosure of Your Protected Health Information. You have the right to request certain restrictions on how We use or disclose Your protected health information for treatment, payment, or healthcare operations. You also have the right to request restrictions on disclosures to family members or others who are involved in Your care or the paying of Your healthcare. To request a restriction, You must send a written request to: Privacy Officer, HIPAA@AlliantPlans.com Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request a restriction can be obtained from the Privacy Officer. We are not required to agree to Your request for a restriction, except for a restriction to disclose Your protected health information to a health plan if the purpose is to carry out payment or healthcare operations which is not otherwise required by law and the protected health information pertains solely to a healthcare item or service for which a person, other than the health plan, has paid the healthcare provider in full. If We agree to Your request for a restriction, You will receive a written acknowledgement from us.

In these cases, we never share your information unless you give us written permission:

• Sale of your information
• Most sharing of psychotherapy notes
• Substance use disorder counseling notes

Receiving Confidential Communications of Your Protected Health Information. You have the right to request communications regarding Your protected health information from Us by alternative means (for example by fax) or at alternative locations. We will accommodate reasonable requests for such alternative means. To request a confidential communication, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request a confidential communication can be obtained from the Privacy Officer.

Access to Your Protected Health Information. You have the right to inspect and/or obtain a copy of Your protected health information We maintain in Your designated record set, with a few exceptions. To request access, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request access to Your protected health information can be obtained from the Privacy Officer. A fee will be charged to You for copying and postage.

Amendment of Your Protected Health Information. You have the right to request an amendment to Your protected health information to correct inaccuracies. To request an amendment, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request an amendment to Your protected health information can be obtained from the Privacy Officer. We are not required to grant the request in certain circumstances.

Accounting of Disclosures of Your Protected Health Information. You have the right to receive an accounting of certain disclosures of Your protected health information made by Us within the six years immediately preceding Your request. To request an accounting, You must send a written request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722. A form to request an accounting of Your protected health information can be obtained from the Privacy Officer. The first accounting in any 12-month period will be free; however, a fee will be charged to You for any subsequent request for an accounting during that same time.

Complaints. If You believe Your privacy rights have been violated, You can send a written complaint to the Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722 or at HIPAA@AlliantPlans.com or to the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint.

If You have any questions or need any assistance regarding this Notice or Your privacy rights, You may contact the Client Services Department at Health One Alliance, LLC at (866) 403-2785. If You would like a copy of this Notice of Privacy Practices, please request a copy at HIPAA@AlliantPlans.com. You have the right to request a paper copy of the Notice by sending Your request to: Privacy Officer, Health One Alliance, LLC, P.O. Box 1128, Dalton, GA 30722.