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EXHIBIT 1-SAMPLE NOTICE OF PRIVACY PRACTICES <br /> THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED <br /> AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION . PLEASE <br /> REVIEW IT CAREFULLY. <br /> Si usted desea una copia de esta notificacion en espanol, por favor comuniquese con un <br /> representante de servicio al cliente utilizando el numero telefonico indicado en su tarjeta de <br /> asegurado, <br /> Health Insurance Portability and Accountability Act- <br /> Administrative Simplification (HIPAA-AS ) <br /> Notice of Privacy Practices <br /> for your group health plan Sponsored by your employer and for which Blue <br /> Cross and Blue Shield of Florida, Health Options , Inc . and/or Florida <br /> Combined Life Insurance Company, Inc . provides claim administration and <br /> other services . <br /> Our Legal Duty <br /> As your health plan , we are required by applicable federal and state laws to maintain the privacy <br /> of your protected health information ( PHI ) . We want you to be aware of our privacy practices , <br /> our legal duties , and your rights concerning your PHI . We will follow the privacy practices that <br /> are described in this notice while it is in effect. This notice took effect April 14, 2003 , and will <br /> remain in effect until a revised notice is issued . <br /> We reserve the right to change our privacy practices and the terms of this notice at any time and <br /> to make the terms of our notice effective for all PHI that we maintain . <br /> Before we make a significant change in our privacy practices , we will change this notice and <br /> send the new notice to you . <br /> How we can use or disclose PHI without a specific authorization <br /> To You : We must disclose your PHI to you , as described in the Individual Rights section of this <br /> notice . <br /> For Treatment : For example : we may disclose your PHI to a doctor, dentist or a hospital when <br /> requested , in order for the treating provider to provide treatment to you . <br /> For Payment : For example : we may use and disclose PHI to pay claims for services provided <br /> to you by doctors , dentists or hospitals . We may also disclose your PHI to a health care <br /> provider or another health plan so that the provider or plan may obtain payment of a claim or <br /> engage in other payment activities . <br /> 12 <br /> HIPAA\BA Amend to ASO Agmt - fini <br /> August 12, 2004 <br />