We may collect, use, or disclose certain information about you. This “protected personal information” (PPI) may include health information, or personal data such as your address, telephone number or Social Security Number. We may receive this information from, or release it to, health care providers, insurance companies, or other sources. This information is collected, used or released for conducting routine business operations such as: • Underwriting and determining your eligibility for benefits and paying claims; • Conducting care management, case management, or quality reviews; and • Fulfilling other legal obligations that are specified in this contract. This information may also be collected, used or released as required or permitted by law. To safeguard your privacy, we take care to ensure that your information remains confidential by having a company confidentiality policy and by requiring all employees to sign it. If a disclosure of PPI is not related to a routine business function, we remove anything that could be used to easily identify you or we obtain your prior written authorization. You also have the right to request inspection and/or amendment of records retained by us that contain your PPI. Please contact Customer Service and ask that a request form be mailed to you. Uniformity This coverage is intended to apply uniformly to all subscribers without discrimination. Venue All lawsuits or legal proceedings brought against us by you or anyone claiming any right under this plan must be filed: • Within 3 years of the date we denied, in writing, the rights claimed under this plan; and • In the State of Washington or the state in which you reside. All suits or legal proceedings brought by us against you shall be filed within the appropriate statutory period of limitation. In all suits or legal proceedings brought by us, venue may lie, at our option, in King County, State of Washington. Your Cooperation You are under a duty to cooperate in a timely and appropriate manner with us in our administration of benefits or in the event of a lawsuit. DEFINITIONS Continuous Loss This term is used and defined in Extended Benefits For Total Disability section of this booklet. Endorsement A separate attachment to this booklet or another part of the contract that specifies changes in the provisions or benefits. Medically Necessary/Medical Necessity For any service or supply which is excluded by Medicare, but which is listed as covered under this plan, Premera will determine medical necessity in accordance with the following definition: 15 Group Plan G/Age
Plan G Certificate - Age (2024) Page 18 Page 20