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www.aptia365.com/atlanticunionbank 32 Copyright 2024 Aptia Insurance Services Group, LLC. All rights reserved.RIGHT TO AMEND YOUR HEALTH INFORMATION THAT IS INACCURATE OR INCOMPLETEWith certain exceptions, you have a right to request that the Plan amend your health information in a designated record set. The Plan may deny your request for a number of reasons. For example, your request may be denied if the health information is accurate and complete, was not created by the Plan (unless the person or entity that created the information is no longer available), is not part of the designated record set, or is not available for inspection (e.g., psychotherapy notes or information compiled for civil, criminal or administrative proceedings).If you want to exercise this right, your request to the Plan must be in writing, and you must include a statement to support the requested amendment. Within 60 days of receipt of your request, the Plan will take one of these actions:%u2022 Make the amendment as requested.%u2022 Provide a written denial that explains why your request was denied and any rights you may have to disagree or file a complaint.%u2022 Provide a written statement that the time period for reviewing your request will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request.RIGHT TO RECEIVE AN ACCOUNTING OF DISCLOSURES OF YOUR HEALTH INFORMATIONYou have the right to a list of certain disclosures of your health information the Plan has made. This is often referred to as an %u201caccounting of disclosures.%u201d You generally may receive this accounting if the disclosure is required by law, in connection with public health activities, or in similar situations listed in the Other Allowable Uses or Disclosures of your Health Information section earlier in this notice, unless otherwise indicated below.You may receive information on disclosures of your health information for up to six years before the date of your request. You do not have a right to receive an accounting of any disclosures made in any of these circumstances:%u2022 For treatment, payment or healthcare operations.%u2022 To you about your own health information.%u2022 Incidental to other permitted or required disclosures.%u2022 Where authorization was provided.%u2022 To family members or friends involved in your care (where disclosure is permitted without authorization).%u2022 For national security or intelligence purposes or to correctional institutions or law enforcement officials in certain circumstances.%u2022 As part of a %u201climited data set%u201d (health information that excludes certain identifying information).In addition, your right to an accounting of disclosures to a health oversight agency or law enforcement official may be suspended at the request of the agency or official.If you want to exercise this right, your request to the Plan must be in writing. Within 60 days of the request, the Plan will provide you with the list of disclosures or a written statement that the time period for providing this list will be extended for no more than 30 more days, along with the reasons for the delay and the date by which the Plan expects to address your request. You may make one request in any 12-month period at no cost to you, but the Plan may charge a fee for subsequent requests. You%u2019ll be notified of the fee in advance and have the opportunity to change or revoke your request.RIGHT TO OBTAIN A PAPER COPY OF THIS NOTICE FROM THE PLAN UPON REQUESTYou have the right to obtain a paper copy of this privacy notice upon request. Even individuals who agreed to receive this notice electronically may request a paper copy at any time.CHANGES TO THE INFORMATION IN THIS NOTICEThe Plan must abide by the terms of the privacy notice currently in effect. This notice takes effect on January 1, 2025. However, the Plan reserves the right to change the terms of its privacy policies, as described in this notice, at any time and to make new provisions effective for all health information that the Plan maintains. This includes health information that was previously created or received, not just health information created or received after the policy is changed. If changes are made to the Plan%u2019s privacy policies described in this notice, you will be provided with a revised privacy notice.COMPLAINTSIf you believe your privacy rights have been violated or your Plan has not followed its legal obligations under HIPAA, you may complain to the Plan and to the Secretary of Health and Human Services. You won%u2019t be retaliated against for filing a complaint. To file a complaint, contact Lesa Kerley, HR-Benefits Department at 757-934-6777 or lesa.kerley@atlanticunionbank.com.CONTACTFor more information on the Plan%u2019s privacy policies or your rights under HIPAA, contact Lesa Kerley, HR-Benefits Department at 757-934-6777 or lesa.kerley@atlanticunionbank.com.