Notice of privacy practices

Important information about your rights and our responsibilities

privacy shield

Protecting your personal health information is important. 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

Would you like to go paperless and read this online or on your mobile app? Go to anthem.com; anthem.com/ca; anthembluecross.com; and sign up to get these notices by email.

 

State notice of privacy practices

When it comes to handling your health information, we follow relevant state laws, which are sometimes stricter than the federal HIPAA privacy law. This notice:

  • 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.

Your personal information

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. 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.

We may receive your PI from others, such as doctors, hospitals or other insurance companies. 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.

 

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 WITH REGARD TO YOUR HEALTH BENEFITS. PLEASE READ CAREFULLY.

 

HIPAA notice of privacy practices

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.

Your Protected Health Information

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:

Payment: We collect, use and share PHI to take care of your account and benefits, or to pay claims for health care you get through your plan.

Healthcare operations: We collect, use and share PHI for our healthcare operations.

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.

Examples of ways we use your information:

  • 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.
  • We may share PHI with your doctor or hospital so that they may treat you.
  • 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.
  • We may collect and use publicly and/or commercially available data about you to support you and help you can get available health plan benefits and services.
  • We may use PHI with technology to support and enable services provided to you.
  • We may use your PHI to create, use or share de-identified data as allowed by HIPAA.
  • We may also use and share PHI directly or indirectly with health information exchanges for payment, health care operations and treatment. If you don’t want your PHI to be shared in these situations, please visit anthem.com/privacy for more information.

Sharing your PHI with you: 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.

Sharing your PHI with others: 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. 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.

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.

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.

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.

Other reasons we may use or share your information:

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:

  • 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 
  • Doing health research.
  • Obeying the law, if it requires sharing your information.
  • Responding to organ donation groups for research and certain reasons.
  • 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.

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.

Authorization: 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.

Genetic information: We cannot use your genetic information to decide whether we’ll give you coverage or decide the price of that coverage.

Race, ethnicity, language, sexual orientation and gender identity: 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.

Your rights

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.
  • 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.
  • 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.
  • 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.
  • 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.
  • Ask for a restriction for services you pay for out of your own pocket: 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.
  • 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.

How we protect information

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.

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. 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.

Potential impact of other applicable laws

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.

To see more information

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 https://www.anthem.com/privacy/.

Calling or texting you

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. 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.

Complaints

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.

Contact information

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.

Copies and changes

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. 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.

Effective date of this notice

The original effective date of this Notice was April 14, 2003. The most recent of this policy is January 2024.

 

Breast reconstruction surgery benefits

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.

You’ll pay your usual deductible, copay and/or coinsurance. For details, contact your plan administrator.

For more information about the Women’s Health and Cancer Rights Act, go to the United States Department of Labor website at www.dol.gov/agencies/ebsa/laws-and-regulations/laws/whcra.

 

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).

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 ocrportal.hhs.gov/ocr/portal/lobby.jsf. and fill out a complaint form at https://www.hhs.gov/ocr/complaints/index.html

 

Get help in your language

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.

 

II. ANNUAL PRIVACY NOTICE

PROTECTING YOUR PRIVACY: Where to Find our Notice of Privacy Practices

Your Rights Concerning Your Protected Health Information

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law governing the privacy of individually identifiable health information. We are required by HIPAA to notify you of the availability of our Notice of Privacy Practices. The notice describes our privacy practices, legal duties and your rights concerning your Protected Health Information. We must follow the privacy practices described in the notice while it is in effect (it will remain in effect unless and until we publish and issue a new notice).

We may use publicly and/or commercially available data about you to provide you with information about available health plan benefits and services. 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 to let you know about treatment options or other health-related benefits and services. If you do not want to be contacted by phone, just let the caller know, and we won’t reach out this way anymore, or call 1-844-203-3796 to add your phone number to our Do Not Call list.

You may obtain a copy of our Notice of Privacy Practices on our website at https://www.anthem.com/privacy/. or you may contact Member Services using the contact information on your identification card.

 

STATE NOTICE OF PRIVACY PRACTICES

As we indicate in our HIPAA Notice of Privacy Practices, we must follow state laws that are more strict than the federal HIPAA privacy law. This notice explains your rights and our legal duties under state law.

Your Personal Information

We may collect, use and share your nonpublic personal information (PI) as described in this notice. PI is information that identifies a person and is often gathered in an insurance matter.

If we use or disclose PI for underwriting purposes, we are prohibited from using or disclosing PI that is genetic information of an individual for such purposes.

We may collect PI about you from other persons or entities such as doctors, hospitals, or other carriers.

We may share PI with persons or entities outside of our company without your OK in some cases.

If we take part in an activity that would require us to give you a chance to opt-out of that activity, we will contact you. We will tell you how you can let us know that you do not want us to use or share your PI for a given activity.

You have the right to access and correct your PI.

Because PI is defined as any information that can be used to make judgments about your health, finances, character, habits, hobbies, reputation, career and credit, we take reasonable safety measures to protect the PI we have about you.

A more detailed state notice is available upon request. Please call the phone number printed on your ID card. Or you may find more information at https://www.anthem.com/privacy/.