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Special Enrollment Rights Under HIPAA

During the enrollment period, if you decline enrollment for yourself or your dependents (including your spouse) because of other health care insurance coverage, you may in the future be able to enroll yourself or your dependents in the health care plan, provided that you request enrollment within 31 days after your coverage ends. To retain your rights for special enrollment, you may be required to certify during enrollment, in writing, that you are covered by another health care plan. In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to enroll yourself and your dependents, provided that you request enrollment within 31 days after marriage, birth, adoption or placement for adoption.

Summary Notice of Privacy Practices

This Summary of Privacy Practices summarizes how medical information about you may be used and disclosed by the Cone Health group health plan(s) (the “Plan”) or others in the administration of your claims, and certain rights that you have. For a complete, detailed description of all privacy practices, as well as your legal rights, please refer to the accompanying Notice of Privacy Practices.

Our Pledge Regarding Medical Information

We are committed to protecting your personal health information. We are required by law to (1) make sure that any medical information that identifies you is kept private; (2) provide you with certain rights with respect to your medical information; (3) give you a notice of our legal duties and privacy practices; and (4) follow all privacy practices and procedures currently in effect.

How the Plan May Use and Disclose Medical Information About You

We may use and disclose your personal health information without your permission to facilitate your medical treatment, for payment for any medical treatments, and for any other health care operation. We will disclose your medical information to employees of the Company for plan administration functions, which may include activities designed

to improve health and reduce health care cost; but those employees may not share your information for employment-related purposes. We may also use and disclose your personal health information without your permission, as allowed or required by law. Otherwise, we must obtain your written authorization for any other use and disclosure of your medical information. We cannot retaliate against you if you refuse to sign an authorization or revoke an authorization you had previously given.

Your Rights Regarding Your Medical Information

You have the right to inspect and copy your medical information, to request corrections of your medical information, and to obtain an accounting of certain disclosures of your medical information. You also have the right to request that additional restrictions or limitations be placed on the use or disclosure of your medical information, or that communications about your medical information be made in different ways or at different locations.

How to File Complaints

If you believe your privacy rights have been violated, you have the right to file a complaint with us or with the Office for Civil Rights. We will not retaliate against you for making a complaint.

Effective Date: April 14, 2004, as amended February 21, 2017