AVERA HEALTH PLANS, INC.

PRIVACY NOTICE

Avera Health Plans Privacy Commitment

AVERA HEALTH PLANS, INC. DOES NOT SELL OR DISCLOSE ANY NONPUBLIC PERSONAL INFORMATION OR NONPUBLIC PERSONAL FINANCIAL INFORMATION ABOUT ITS SUBSCRIBERS OR MEMBERS TO ANY COMPANIES NOT AFFILIATED WITH AVERA HEALTH PLANS, INC. OR TO ANYONE ELSE, EXCEPT AS REQUIRED BY LAW.

The Type of Information We Collect

Avera Health Plans, Inc. (“Avera Health Plans”) collects both nonpublic personal financial and nonpublic personal information about subscribers and members on application forms, through telephone requests, and through other forms of communication, such as letters. This information is needed to underwrite the policy, process claims, provide follow-up care with an insured and provide the optimum level of cost effective health care. “Nonpublic personal financial information” includes, for example, any list of individual names and street addresses that is not publicly available, social security numbers, policy account numbers, and salary information. “Nonpublic personal information” includes health information which can be a person’s past, present, or future physical, mental, or behavioral health condition.

Avera Health Plans shall maintain the privacy, security and confidentiality of all nonpublic personal information transmitted or received through or maintained in connection with its contractual relationship in accordance with (i) all applicable statutes and regulations, including without limitation the applicable requirements, regulations and policies, and advisory opinions, from time to time promulgated and published thereunder and with respect thereto as from time to time amended, and (ii) the protocols, rules, policies and other requirements of accrediting agencies, licensors and authorities that are applicable to the operation of Avera Health Plans. Avera Health Plans restricts access to nonpublic personal financial and nonpublic personal information that it has obtained to those employees or affiliated companies under contract who need to know such information to provide timely and accurate claims processing, utilization management, quality control, and cost effective follow-up patient care. Avera Health Plans maintains policies and procedures that comply with federal regulations to guard your nonpublic personal and financial information from improper disclosures.

This Privacy Notice is available on Avera Health Plans website at www.AveraHealthPlans.com. If you have any questions about this Privacy Notice, call Avera Health Plans at 605-322-4545 or contact us at 3816 S Elmwood Avenue, Suite 100, Sioux Falls, SD 57105.

ENR-FORM-005 (07/08) AHP Privacy Notice