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MVP HEALTH PLAN INC., MVP HEALTH SERVICES CORP., MVP HEALTH INSURANCE COMPANY, MVP HEALTH PLAN OF NEW HAMPSHIRE, INC. AND MVP HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE, INC.

PRIVACY NOTICE
Effective April 14, 2003

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.

At MVP Health Plan, Inc., MVP Health Services Corp., MVP Health Insurance Company, MVP Health Plan of New Hampshire, Inc. and MVP Health Insurance Company of New Hampshire, Inc., we respect the confidentiality of your health information and will protect your information in a responsible and professional manner. We are required by law to maintain the privacy of your health information, provide you with this notice of our privacy practices and legal duties and to abide by the terms of this notice.

This notice explains how we may use and disclose your health information to carry out payment and health care operations and for other purposes that are permitted or required by law. When we talk about “health information” in this notice we mean claim information and any other information that relates to your past, present or future physical or mental health.

How We Use or Disclose Your Health Information

The following are ways we may use or disclose your health information:

For Payment. We may use and disclose your health information to provide payment to health care providers who render treatment on your behalf.

For Health Care Operations. We may use or disclose your health information for health care operations that are necessary to enable us to arrange for the provision of health benefits, the payment of health claims, and to ensure that MVP members receive quality service. For example, we may use and disclose your health information to conduct quality assessment and improvement activities, case management and care coordination, licensing, credentialing, underwriting, premium rating, fraud and abuse detection, medical review and legal services.

Appointment Reminders. We may use or disclose your health information to send you a reminder that you have an appointment with your doctor for treatment or medical care.

Health-Related Benefits and Services. We may use or disclose your health information to tell you about alternative medical treatments and programs or about health related products and services that may be of interest to you.

Disclosures to Plan Sponsor. We may disclose your health information to the plan sponsor of your group health plan (usually your employer) so that the plan sponsor may obtain premium bids, modify, amend or terminate your group health plan and perform enrollment functions on your behalf. If we obtain assurances as required by law from your plan sponsor, including an assurance that it will not use your health information for any employment related decisions, we may also disclose your health information to your plan sponsor so that it can carry out other administrative functions on behalf of your group health plan related to your treatment, payment of your claims and the health care operations of your group health plan.

SPECIAL USE AND DISCLOSURE SITUATIONS

Uses and Disclosures required by law. We may use and disclose health information about you when we are required to do so by federal, state or local law.
Public Health. We may disclose your health information for public health activities. These activities include preventing or controlling disease, injury or disability; reporting births or deaths; or reporting reactions to medications or problems with medical products or to notify people of recalls of products they have been using.
Health Oversight. We may disclose your health information to a health oversight agency that monitors the health care system and government programs for designated oversight activities.
Legal Proceedings. We may disclose your health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized) and, in certain situations, in response to a subpoena, discovery request or other lawful process.
Law Enforcement. We may disclose your health information, so long as applicable legal requirements are met, for law enforcement purposes.
Abuse or Neglect. We may disclose your health information to a public health authority, or other government authority authorized by law to receive reports of child abuse, neglect or domestic violence consistent with the requirements of applicable federal and state laws.
Coroners, Funeral Directors and Organ Donation. We may disclose your health information to a coroner or medical examiner to identify a deceased person, determine a cause of death or as authorized by law. We may also disclose your health information to funeral directors as necessary to carry out their duties. If you are an organ donor, we may release your health information for procurement, banking or transplantation.
Research Purposes. In certain circumstances, we may use and disclose your health information for research purposes.
Criminal Activity. We may disclose your health information when necessary to prevent or lessen serious and imminent threat to the health and safety of a person or the public.
Military Activity. We may disclose your health information to authorized federal officials if you are a member of the military (or a veteran of the military).
National Security. We may disclose your health information to authorized federal officials for national security, intelligence activities and to enable them to provide protective services for the President and others.
Workers Compensation. We may disclose your health information as authorized to comply with workers compensation laws and other similar legally-established programs.

What Are Your Rights

The following are your rights with respect to your health information. Requests for restrictions, confidential communications, accounting of disclosures, amendments to your health information or to inspect or copy your health information, can be made by contacting us at the Member Services Department c/o MVP Health Care, P.O. Box 2207, 625 State Street, Schenectady, NY 12301 or call 1-888-MVP-MBRS (1-888-687-6277).

Right to Request Restrictions. You have the right to request a restriction or limitation on your health information we disclose for payment or health care operations. While we will try to honor your request, we are not legally required to agree to restrictions or limitations. If we agree, we will comply with your request or limitations except in emergency situations.

Right to Request Confidential Communications. You have the right to request that we communicate with you about your health information in a certain way or at a certain location if disclosure of information could endanger you. We will accommodate your reasonable request.

Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures of your health information made by us except for those necessary to carry out payment and health care operations, disclosures made to you, or in certain other situations.

Right to Inspect and Copy. You have the right to inspect and obtain a copy of certain health information that we maintain to make decisions about you.

Right to Amend. If you feel that the health information we maintain about you is incomplete or inaccurate, you may ask us to amend the information.

In certain circumstances we may deny your request. If we deny the request, we will explain your right to file a written statement of disagreement. If we approve your request, we will include the change in your health information and tell others that need to know about your changes.

In limited circumstances, we may deny your request to inspect or obtain a copy of your health information. If we deny your request, we will notify you in writing of the reason for the denial and if applicable the right to have the denial reviewed.

Exercising Your Rights

Unless you provide us with a written authorization, we will not use or disclosure your health information in any manner not covered by this notice. If you authorize us in writing to use or disclose your health information in a manner other than described in this notice, you may revoke your authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your health information for the reasons covered by your authorization; however, we will not reverse any uses or disclosures already made in reliance on your authorization before it was revoked.

You have a right to receive a paper copy of this notice at any time. You can also view this notice on our Web site at www.mvphealthcare.com.

We reserve the right to change the terms of this notice at any time, consistent with applicable law, and to make those changes effective for health information we already have about you. Once revised, we will provide the new notice to you by mail and post it on our Web site (www.mvphealthcare.com).

If you have any questions about this notice, please contact Member Services at MVP Health Care, 625 State Street, Schenectady, NY 12305 or call 1-888-MVP-MBRS (1-888-687-6277)

If you believe your privacy rights have been violated, you may file a written complaint with the Complaints Coordinator at MVP Health Care, P.O. Box 2207, 625 State Street, Schenectady, NY 12305 or you may contact us at 1-888-MVP-MBRS (1-888-687-6277). You may also notify the Secretary of the U.S. Department of Health and Human Services of your compliant. WE WILL NOT TAKE ANY ACTION AGAINST YOU FOR FILING A COMPLAINT.