You have the right to: • Seek care from any licensed dentist in Washington or nationally. Our reimbursement for such care varies depending on your choice (Delta member / non-member), but you can receive care from any dentist you choose. • Participate in decisions about your oral health care. • Be informed about the oral health options available to you and your family. • Request information concerning benefit coverage levels for proposed treatments prior to receiving services. • Have access to specialists when services are required to complete a treatment, diagnosis or when your primary care dentist makes a specific referral for specialty care. • Contact DDWA customer service personnel during established business hours to ask questions about your oral health benefits. Alternatively, information is available on our website at deltadentalwa.com • Appeal in writing, decisions or grievances regarding your dental benefit coverage. You should expect to have these issues resolved in a timely, professional and fair manner. • Have your individual health information kept confidential and used only for resolving health care decisions or claims. • Receive quality care regardless of your gender, race, sexual orientation, marital status, cultural, economic, educational or religious background. To receive the best oral health care possible, it is your responsibility to: • Know your benefit coverage and how it works. • Arrive at the dental office on time or let the dental office know well in advance if you are unable to keep a scheduled appointment. Some offices require 24 hours’ notice for appointment cancellations before they will waive service charges. • Ask questions about treatment options that are available to you regardless of coverage levels or cost. • Give accurate and complete information about your health status and history and the health status and history of your family to all care providers when necessary. • Read carefully and ask questions about all forms and documents which you are requested to sign, and request further information about items you do not understand. • Follow instructions given by your dentist or their staff concerning daily oral health improvement or post- service care. • Send requested documentation to DDWA to assist with the processing of claims. • If applicable, pay the dental office the appropriate co-payments amount at time of visit. • Respect the rights, office policies and property of each dental office you have the opportunity to visit. • Inform your dentist and your employer or the PEBB Program promptly of any change to your or a dependent’s address, telephone, or family status. HIPAA Disclosure Policy Delta Dental of Washington maintains a Compliance Program which includes an element involving maintaining privacy of information as it relates to the HIPAA Privacy & Security Rule and the Gramm-Leach Bliley Act. As such we maintain a HIPAA Privacy member helpline for reporting of suspected privacy disclosures, provide members a copy of our privacy notice, track any unintended disclosures, and ensure the member rights are protected as identified by the Privacy Rule. Policies and procedures are maintained and communicated to DDWA employees with reminders to maintain the privacy of our member’s information. We also require all employees to participate in HIPAA Privacy & Security training through on-line education classes, email communications, and periodic auditing. 2024-01-03000-BB 38 LG PPOL 20240101