Common use of Right to an Accounting of Disclosures Clause in Contracts

Right to an Accounting of Disclosures. You have the right to receive a list of disclosures of your health information that have been made by Fidelis. The list will not include disclosures made for certain types of purposes, such as disclosures for treatment, payment or health care operations or disclosures you authorized in writing. Your request should specify the time period for which you want this list, which can be no longer than six (6) years and may not include dates prior to April 14, 2003. The first time you ask for a list of disclosures in any 12-month period, we will provide it for free. If you request additional lists during a 12-month period, we may charge you a fee to cover our costs in providing the additional lists. You may request a list of disclosures by writing to : Fidelis Care, Member Services, 00-00 Xxxxxx Xxxxxxxxx, Xxxx Xxxx, New York 11374.