IMPORTANT NOTICE TO ALL INSUREDS

Your Privacy is Important to Us

Medical Mutual of Ohio has always been committed to protecting the information you share with us and is required by law to maintain the privacy of your personal information as well as your protected health information. Please review our privacy policy below.

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Medical Mutual of Ohio holds its employees and consultants to strict policies and procedures protecting your information. Medical Mutual of Ohio is required by law to provide you this Notice of its duties and privacy practices. All employees must sign confidentiality agreements. In addition, Medical Mutual of Ohio employs various technologies to prevent unauthorized access to data. This Privacy Statement will explain the type of information we collect, how we use that information, how we protect that information, your rights as they relate to your information and our legal duties and privacy practices.

What Information We Collect

Medical Mutual of Ohio understands your concerns regarding the confidentiality of information you share with us. We collect information from you on applications and other transactions with us. This information can include name, address and social security number. Under certain conditions we may also ask you and your covered dependents for medical history information. We also have access to your information through claims submitted to our company from healthcare providers, information provided by your employer if your coverage is through a group contract and from your agent.

How We Use and Disclose Your Information

We are permitted by law to use your information for certain purposes including healthcare payment and healthcare operations. Examples of how we may use and disclose your information include but are not limited to:

Payment: Medical Mutual of Ohio may use or disclose your information to pay claims for covered services or to provide eligibility information to your doctor when you receive treatment.

Healthcare Operations: Medical Mutual of Ohio may use or disclose your information for activities like (1) underwriting, premium rating or other activities relating to the creation or renewal of a health insurance contract; (2) quality assessment and improvement activities such as peer review and credentialing of providers; (3) care and disease management activities; and (4) data and information systems management.

As required by law: Medical Mutual of Ohio must allow the U.S. Department of Health and Human Services access to audit its records. In addition, Medical Mutual of Ohio may be required to release your information to comply with other laws including:

• To comply with legal proceedings, such as court orders or administrative order or subpoenas.
• To perform mandatory licensing, regulatory/compliance reporting.
• To law enforcement officials for limited law enforcement purposes.
• To federal officials for lawful intelligence, counterintelligence and other national security purposes.
• To Public Health Authorities for public health purposes.
• To comply with workers’ compensation and other similar programs established by law that provide for benefits for work-related injuries or illness without regard to fault.
• To Business Associates: Medical Mutual of Ohio may disclose your information to third parties that it hires to assist in the administration of your benefits. These third parties are called Business Associates and they must agree in writing to protect and maintain the confidentiality and security of your information. Examples of a Business Associate are the doctors who do medical reviews and our brokers who service your policy.
• To Plan Sponsors: If you receive insurance benefits through a group plan, Medical Mutual of Ohio may disclose to your Plan Sponsor, in summary form, claims history and other similar information. Such summary information does not disclose your name or other distinguishing characteristics. Medical Mutual of Ohio may also disclose to your Plan Sponsor the fact that you are enrolled in, or disenrolled from the Plan. Medical Mutual of Ohio may disclose your medical information to the Plan Sponsor for Plan administrative functions that the Plan Sponsor provides to the Plan if the Plan Sponsor agrees in writing to ensure the continuing confidentiality and security of your medical information. The Plan Sponsor must also agree not to use or disclose your medical information for employment-related activities or for any other benefit or benefit plans of the Plan Sponsor.

Other Uses and Disclosures: Other disclosures that Medical Mutual of Ohio may make:

• To your personal representative appointed by you or designated by law.
• To appropriate military authorities, if you are a member of the armed forces.
• To a family member, friend or other person, for the purpose of helping you with your healthcare or healthcare payment if you are in an emergency situation and you cannot give your agreement to Medical Mutual of Ohio to do this.
• To inform you of other health related benefits or services that may be of interest to you.
• Uses and Disclosures with your permission: Medical Mutual of Ohio will not use or disclose your information for any purpose not outlined in this notice unless you give Medical Mutual of Ohio your written authorization to do so. We do not make disclosures of information to any other companies that may want to sell their products or services to you. If you give Medical Mutual of Ohio your written authorization, you may revoke that authorization at any time unless Medical Mutual of Ohio has taken action in reliance of your authorization. To receive an authorization form, please contact Customer Service at the telephone number on the back of your identification card or print one from our website, Medmutual.com under the Member Services Section. If a family member calls with knowledge of your claim, we may confirm certain information about it, unless you have informed us in writing of a need for confidential communication.

Your Rights

Below are your privacy and confidentiality rights as a member of Medical Mutual of Ohio. Please note that all requests must be made in writing. We have provided forms to help in processing your request. The appropriate forms are available under the Member Services Section at our web-site, www.medmutual.com. . You also may call Customer Service at the telephone number on the back of your identification card to obtain a copy of this form. Hearing-impaired customers may contact us at 800/851-0479 or 800/982-8109. All completed forms and requests are to be mailed to:

Medical Mutual of Ohio
P.O. Box 89499
Cleveland, Oh 44101-6499

Requests with incomplete information will not be processed and you will not be notified.

Restriction: You may request that Medical Mutual of Ohio place additional restrictions on the use and disclosure of your information to carry out treatment, payment or healthcare operations. Medical Mutual of Ohio does not have to agree to your request. Please use the form provided under the Member Services Section at our web site www.medmutual.com to submit your request. Be sure to provide all required information including your name, your birthday, the policy number under which you are covered, and a clear explanation of your request. Medical Mutual of Ohio will send a written confirmation regarding the disposition of your request.

Confidential Communication: You may request that Medical Mutual of Ohio communicate with you in confidence about your information at a different location. Medical Mutual of Ohio does not have to honor this request unless (1) such a change in communication is necessary to avoid endangering you; (2) your request allows Medical Mutual of Ohio to continue collecting premiums and pay claims; and (3) your request is reasonable. Please use the form provided under the Member Services Section at our web site, www.medmutual.com to submit your request. Be sure to provide all required information including your name, your social security number, your group number, your birthday, the policy number under which you are covered, the full address of where you would like future communication to be sent and the reason for the request.

The request will take ten (10) business days to process from the date received. You will receive a letter confirming the activation of the alternate address. All communications regarding your information will be sent to the alternate address once this request has been made or until you notify us otherwise. Use of an alternate address cannot be applied to communications sent prior to processing your request.

Access to your information: You have a right to access your information used and stored by Medical Mutual of Ohio in its designated record set. For access to your entire medical record, you will have to contact the provider of service. Please use the form provided under the Member Services Section at our web site, www.medmutual.com to submit your request for Access to your records. Be sure to provide all required information including your name, your birthday, the policy number under which you are covered, the group number under which you are covered, your social security number, the information you would like to access and the dates of information you would like to see (if applicable).

Amend your information: You have the right to request an amendment of your information. Medical Mutual of Ohio cannot amend information it did not create and will refer you to the provider of service if you are requesting an amendment to diagnosis or treatment information. Please use the form provided under the Member Services Section at our web site, www.medmutual.com to submit your request to amend your records. Be sure to provide all required information including your name, your birthday, the policy number under which you are covered, the information you are requesting be amended, and an explanation as to why you believe the information is incorrect or incomplete. You have a right to an appeal if your request to an amendment is denied. These rights will be explained to you if your request is denied.

Disclosures: You have a right to an accounting of certain disclosures of your information made by Medical Mutual of Ohio and its Business Associates over the last six (6) years (but not for disclosures made before April 14, 2003). Please use the form provided under the Member Services Section at our web site, www.medmutual.com to submit your request for an Accounting of Disclosures of your records. Be sure to provide all required information including your name, your birthday, the policy number under which you are covered, and a statement explaining your specific request.

Complaints: You have the right to complain if you believe your rights have been violated. You may use the form provided under the Member Services Section at our web site, www.medmutual.com to submit your complaint. Please provide all required information including your name, your birthday, the policy number under which you are covered, and an explanation regarding your complaint in as much detail as possible. You may file a complaint by contacting Customer Service at the telephone number on the back of your identification card, if you wish not to send it in writing.

You also have the right to complain to the Secretary of the U.S. Department of Health and Human Services, Hubert Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Federal law prohibits retaliation against you if you chose to file a complaint.

Contact Information: If you have questions or would like an additional copy of this notice, please contact Customer Service at the telephone number on the back of your identification card.

Security Procedures

Medical Mutual of Ohio takes the security of your information very seriously and has established security standards and procedures to prevent unauthorized access to customer information. We maintain physical, electronic and procedural safeguards to guard your information. All authorized personnel within our organization who deal with your information must abide by a confidentiality agreement.

Links to Other Sites

This site may contain links to other Web sites, even though you may still see our logo; you are providing information to these other sites when you leave our site. We will notify you when you are leaving our site. We are not responsible for the privacy practices or the contents of such other Web sites. You should review the posted statement at the sites you go to from our site.

E-Mail

All information and correspondence you share with us will be handled in the strictest confidence. Please note that the email facilities on our Web site (unlike those areas within the site) do not provide the same level of security. For that reason, please do not email to communicate information to us that you consider confidential. If you wish, you may contact us instead via telephone at the Customer Service number located on your identification card.

Cookies and Other Methods of Collecting Information

Medical Mutual of Ohio uses various methods to collect certain other kinds of information that cannot be personally identified with you, including "cookies", "referrers", IP addresses, and environment variables. A "cookie" is an element of data that Medical Mutual of Ohio can send to your browser, which may then store it on your system. It can be used to provide you with a tailored user experience. The Medical Mutual of Ohio site uses cookies. We treat any personally identifiable information with the same confidentiality as when you enrolled. You can set your browser to notify you when you receive a cookie, giving you the chance to decide whether or not to accept it. Medical Mutual of Ohio does not require that you accept cookies. A "referrer" is the information passed along by a web browser that references the Web URL you linked from, and is automatically gathered by our Web server. This information is used by Medical Mutual of Ohio to identify broad demographic trends that may be used to provide information tailored to your interests. You will not be personally identified from this information.

Your computer uses IP addresses every time you are connected to the Internet. Your IP address is a number that is used by computers on the network to identify your computer so that data (such as the Web pages you request) can be sent to you. Our Web server automatically gathers them. Medical Mutual of Ohio will not use your IP address to attempt to identify your personal information and you will remain anonymous. System Information we gather includes time, type of Web browser being used, the operating system/platform, and CPU speed. This information is sent automatically by your Web browser when you are connected to a Web site and is used by Medical Mutual of Ohio only for broad demographic statistics. You will not be personally identified from this information.

Effective Date

The effective date of this notice is April 14, 2003. Medical Mutual of Ohio is required to follow the terms of this notice until it is replaced. Medical Mutual of Ohio reserves the right to change this Privacy Statement at any time as allowed by law and will notify you of any changes as required by law. Medical Mutual of Ohio reserves the right to make the changes apply to all information that it maintains.