The Plan is required by law to:

• Make sure that health information that identifies you is kept private;
• Give you notice of the Plan's legal duties and privacy policies regarding your health information; and
• Follow the terms of this section until modified.

To Make or Obtain Payment. The Plan may use and disclose health information about you to determine eligibility for benefits and to determine benefit responsibility under the Plan. For example, the Plan may have your medical claim forms reviewed by a third party to determine whether the expense incurred is an expense incurred for medical care under Section 213 of the Code.

To Facilitate Treatment. The Plan may use and disclose your health information to facilitate treatment or services by providers, including coordination or management of health carrier related services. For example, the Plan may disclose health information about you with physicians who are treating you.

To Coordinate Health Care Operations. The Plan may use and disclose your health information to facilitate the administration of the Plan. These uses and disclosures are necessary to run the Plan. For example, health care operations include such activities as:

• Quality assessment and improvement activities;
• Activities designed to improve health or reduce health care costs;
• Clinical guideline and protocol development, case management and care coordination;
• Contacting health care providers and participants with information about treatment alternatives and other related functions;
• Health care professional competence or qualification review and performance evaluation;
• Accreditation, certification, licensing and credentialing activities;
• Underwriting, including stop-loss underwriting, premium rating and related functions to create, renew or replace health insurance or health benefits;
• Review and auditing, including compliance reviews, medical reviews, legal services, fraud and abuse detection and compliance programs;
• Business planning and development, including cost management and planning related to analyses and formulary development; and
• Business management and general administration activities of the Plan, including customer service and resolution of appeals and grievances.

When Required by Law. The Plan will disclose health information about you when required to do so by federal, state or local law. For example, the Plan may disclose health information when required by a court order in a lawsuit such as a malpractice case.

To Avert a Serious Threat to Health or Safety. The Plan may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person. Any disclosure, however, will only be made to someone able to help prevent the threat. For example, the Plan may disclose health information about you in a proceeding regarding the licensure of a physician.

Military and Veterans. If you are a member of the armed forces, the Plan may release health information about you as required by military command authorities. The Plan may also release health information about foreign military personnel to the appropriate foreign military authority.

For Treatment Alternatives. The Plan may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

For Distribution of Health-Related Benefits and Services. The Plan may use and disclose your health information to provide information on health-related benefits and services that may be of interest to you.

For Disclosure to the Board of Trustees. The Plan may disclose your health information to another health plan maintained by the Harrison Trust or to the Board of Trustees for plan administration functions performed by the Board of Trustees on behalf of the Plan. In addition, the Plan may provide summary health information to the Board of Trustees so that the Board of Trustees may solicit premium bids from health insurers or modify, amend or terminate the Plan. The Plan may also disclose to the Board of Trustees information whether you are participating in the Plan.

A Family Member or Close Personal Friend Involved in Your Health Care. The Plan may make your health information known to a family member or close personal friend. Disclosure of your health information will be determined based on how involved the person is in your health care or payment of your health care claims. For example, the Plan would normally provide information to a family member confirming eligibility for health coverage or if a claim was paid but not the specific treatment or diagnosis provided or the reason the provider was consulted. The Plan may release health information to parents or guardians, if allowed by law. If you are not present or able to agree to these disclosures of your health information, the Plan through its Plan Administrator or Administrative Agent may use its professional judgment to determine whether the disclosure is in your best interest. If you do not want your health information disclosed to a family member or close personal friend as outlined in this section, you must notify the Plan as described in the Right to Request Restrictions at the end of this section.

Personal Representative. The Plan will disclose your health information to an individual who has been designated as your personal representative and has qualified for such designation in accordance with relevant state law. However, before the Plan will disclose health information to such a person, you must submit a written notice of his/her designation, along with the documentation that supports his/her qualification, such as a power of attorney.

Even if you designate a personal representative, federal law permits the Plan to elect not to treat the person as your personal representative if the Plan has a reasonable belief that: (1) you have been, or may be, subject to domestic violence, abuse or neglect by such person; (2) treating such a person as your personal representative could endanger you; or (3) the Plan determines, in its professional judgment, that it is not in your best interest to treat the person as your personal representative.

Business Associates. Business associates perform various functions and services on behalf of the Plan. For example, the Administrative Agent, A&I Benefit Plan Administrators, Inc., will be handling many of the functions in connection with the operation of the Plan. To perform these functions, or provide the services, the Plan's business associates may receive, create, maintain, use or disclose your health information, but only after agreeing, in writing, to appropriate safeguards concerning your health information.

Other Covered Entities. The Plan may use or disclose your health information to assist health care providers in connection with their treatment or payment activities or to assist other covered entities in connection with payment activities and certain health care operations. For example, the Plan may disclose your health information to a health care provider when needed by the provider to render treatment to you or the Plan may disclose health information to another covered entity to conduct health care operations in the area of quality assurance.

To Conduct Health Oversight Activities. The Plan may disclose your health information to a health oversight agency for authorized activities, including audits, civil, administrative or criminal investigations, inspections, licensure or disciplinary action. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws. However, the Plan may not disclose your health information if you are the subject of an investigation and the investigation does not arise out of or is not directly related to your receipt of health care or public benefits.

Legal Proceedings. The Plan may disclose your health information: (1) in the course of any judicial or administrative proceeding; (2) in response to an order of a court or an administrative tribunal (to the extent such disclosure is expressly authorized); and (3) in response to a subpoena, discovery request or other lawful process once the Plan has met the administrative requirements of the Health Insurance Portability and Accountability Act of 1996 (hereinafter the "HIPAA Privacy Rule"). For example, the Plan may disclose your health information in response to a subpoena for such information, but only after the Plan meets certain conditions required by the HIPAA Privacy Rule.

Law Enforcement. Under certain conditions, the Plan may disclose your health information to law enforcement officials. Some of the reasons for such a disclosure include, but are not limited to: (1) it is required by law or some other legal process; (2) it is necessary to locate or identify a suspect, fugitive, material witness or missing person; and (3) it is necessary to provide evidence of a crime that occurred.

National Security and Intelligence. In certain circumstances, federal regulations require the Plan to disclose your health information to facilitate specified government functions related to national security, intelligence activities and other national security activities authorized by law.

Abuse or Neglect. The Plan may disclose your health information to a governmental entity that is authorized by law to receive reports of abuse, neglect or domestic violence. Additionally, as required by law, the Plan may disclose to a governmental entity authorized to receive such information your health information if the Plan believes that you have been a victim of abuse, neglect or domestic violence.

Research. The Plan may disclose your health information to researchers when an institutional review board or privacy board has: (1) reviewed the research proposal and established protocols to ensure the privacy of your health information; and (2) approved the research.

Inmates. If you are an inmate of a correctional institution, the Plan may disclose your health information to the correctional institution or to a law enforcement official for: (1) the institution to provide health care to you; (2) your health and safety and the health and safety of others; or (3) the safety and security of the correctional institution.

Coroners, Medical Examiners, Funeral Directors and Organ Donation. The Plan may disclose health information to a coroner or medical examiner for purposes of identifying a deceased person, determining a cause of death, or for the coroner or medical examiner to perform other duties authorized by law. The Plan may also disclose, as authorized by law, information to funeral directors so they may carry out their duties. Further, the Plan may disclose health information to organizations that handle organ, eye or tissue donation and transplantation.

Workers' Compensation. The Plan may release your health information to the extent necessary to comply with workers' compensation laws and other similar programs that provide benefits for work-related injuries or illnesses.

Disclosures to the Secretary of the U.S. Department of Health and Human Services. The Plan is required to disclose your health information to the Secretary of the U.S. Department of Health and Human Services when the Secretary is investigating or determining the Plan's compliance with the HIPAA Privacy Rule.

Right to Request Restrictions. You have the right to request restrictions or limitations on the health information the Plan uses or discloses about you for treatment, payment or health care operations. You have the right to request a limit on the Plan's disclosure of your health information to someone involved in your care or the payment for your care. However, the Plan is not required to agree to your request. If the Plan does agree to the restriction, the Plan will comply with the restriction unless the information is needed to provide emergency medical treatment.

To request restrictions, you must make your request in writing on the form provided, to the Client Service Representative for the Harrison Trust in writing at the address at the end of this section. In your written request, you must tell the Plan:

• What information you want to limit;
• Whether you want to limit the Plan's use, disclosure or both; and
• To whom you want the limits to apply, for example, non-disclosure to your spouse.

Right to Receive Confidential Communications. You have the right to request that the Plan communicate with you about health matters in a manner other than by mail or at an alternative location if you feel the disclosure of your health information could endanger you. For example, you may ask that the Plan communicate with you only at a certain post office box, telephone number or by e-mail.

To request confidential communications, you must make your request in writing to the Client Service Representative for the Harrison Trust at the address at the end of this section. The Plan will not ask you the reason for the request. The Plan will attempt to honor all reasonable requests. Your written request must specify how or where you wish to receive confidential communications.

Right to Inspect and Copy Your Health Information. You have the right to inspect and copy your health information. A request to inspect and copy records containing your health information must be made in writing to the Client Service Representative for the Harrison Trust at the address at the end of this section. If you request a copy of your health information, the Plan may charge a reasonable fee for copying, assembling and postage.

Right to Amend Your Health Information. If you believe that your health information records are inaccurate or incomplete, you may request that the Plan amend its records. The request may be made as long as the health information is maintained by the Plan.

A request for an amendment of health information records must be made in writing to the Client Service Representative for the Harrison Trust at the address at the end of this section. The Plan may deny the request if it does not include a reason to support the amendment. The request may also be denied if your health information records were not created by the Plan, if the health information you are requesting to amend is not part of the Plan's records, if the health information you wish to amend falls within an exception to the health information you are permitted to inspect and copy, or if the Plan determines that records containing your health information are accurate and complete.

Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures of your health information when the disclosure was made for any purpose other than treatment, payment, health care operations or when disclosures are not in accordance with this Notice of Privacy Practices and applicable law. An accounting of disclosures is not required for disclosures made pursuant to a signed authorization by you or your personal representative. Most disclosures of your health information will be for purposes of treatment, payment or health care operations and, therefore, will not be subject to your right to an accounting.

The request for an accounting must be made in writing to the Client Service Representative for the Harrison Trust at the address at the end of this section. The accounting request should specify the time period for which you are requesting the accounting but may not start earlier than April 14, 2003. Accounting requests may not be made for periods of time going back more than six (6) years. The Plan will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee. The Plan will inform you of the fee in advance.

Right to a Paper Copy of this Notice. You have the right to request and receive a paper copy of this Notice at any time, even if you have received this Notice previously or agreed to receive the Notice electronically. To receive a paper copy, please contact the Client Service Representative for the Harrison Trust at the address at the end of this section.

The Plan has designated the Harrison Trust's Client Service Representative for all issues regarding this section and your privacy rights. You may contact this person at:

Client Service Representative
Harrison Electrical Workers Trust Fund
1220 SW Morrison Street
Suite 300
Portland, OR 97205

In Portland: (503) 224-0048, extension 1679
Outside Portland: (800) 547-4457, extension 1679

IF YOU HAVE ANY QUESTIONS REGARDING THIS SECTION, PLEASE CONTACT CLIENT SERVICE REPRESENTATIVE AT THE ADDRESS AND TELEPHONE NUMBER LISTED ABOVE.