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Right to Request Confidential Communications You have the right to request that communications involving your PHI be provided to you at a certain location or in a certain way. Any such request must be made in writing. The Plan will accommodate any reasonable request if the normal method of communication would place you in danger and that danger is stated in your request.

Right To Access Your Protected Health Information You have the right to inspect and copy your PHI maintained in a “designated record set” by the Plan. The designated record set consists of records used in making payment, claims adjudication, medical management, and other operations. The Plan may ask that such requests be made in writing and may charge reasonable fees for producing and mailing the copies. The Plan may deny such requests in certain cases.

Right to Request Amendment You have the right to request that your PHI created by the Plan and maintained in a designated record set be amended. Any such request must be made in writing and must include the reason for the request. If the Plan denies your request for amendment, you may file a written statement of disagreement. The Plan has the right to issue a rebuttal to your statement, in which case, a copy will be provided to you.

Right to Receive An Accounting of Disclosures You have the right to receive an accounting of all disclosures of your PHI that the Plan has made, if any. This accounting does not include disclosures for payment or health care operations or certain other purposes, or disclosures to you or with your permission. Any such request must be made in writing and must include a time period, not to exceed six (6) years. The Plan is only required to provide an accounting of disclosures made on or after April 14, 2003. If you request an accounting more than once in a 12-month period, the Plan may charge you a reasonable fee.

All requests listed above should be submitted in writing to the Department of Finance and Administration, Office of Insurance.

COMPLAINTS You have the right to file a complaint if you think your privacy rights have been violated. You may file a complaint with the Plan by writing to the Department of Finance and Administration, Office of Insurance, Attention: Privacy Officer at the address listed in this Notice. You may also file a complaint by writing to the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

PRIVACY CONTACT If you have any questions regarding this Notice, please contact the Department of Finance and Administration, Office of Insurance by mail at P. O. Box 24208, Jackson, MS 39225-4208 or by phone in the Jackson area at 601-359-3411, or toll-free at 866-586- 2781.

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