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Right to a Paper Copy of This NoticeYou have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even ifyou have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain apaper copy of this notice, telephone or write the Privacy Officer as provided above under Contact Information.31ComplaintsIf you believe that your privacy rights have been violated, you may file a complaint with the Plan or with the Office forCivil Rights of the United States Department of Health and Human Services. You can file a complaint with the U.S.Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue,S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-acomplaint/complaint-process/index.html.To file a complaint with the Plan, telephone write the Privacy Officer as provided above under Contact Information.You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office of Civil Rights orwith us. You should keep a copy of any notices you send to the Plan Administrator or the Privacy Officer for yourrecords. Premium Assistance Under Medicaid and the Children%u2019s Health Insurance Program (CHIP)If you or your children are eligible for Medicaid or CHIP and you%u2019re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from theirMedicaid or CHIP programs. If you or your children aren%u2019t eligible for Medicaid or CHIP, you won%u2019t be eligible for thesepremium assistance programs, but you may be able to buy individual insurance coverage through the HealthInsurance Marketplace. For more information, visit www.healthcare.gov.If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact yourState Medicaid or CHIP office to find out if premium assistance is available.If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of yourdependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877- KIDS NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program thatmight help you pay the premiums for an employer-sponsored plan.If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under youremployer plan, your employer must allow you to enroll in your employer plan if you aren%u2019t already enrolled. This iscalled a %u201cspecial enrollment%u201d opportunity, and you must request coverage within 60 days of being determinedeligible for premium assistance. If you have questions about enrolling in your employer plan, contact theDepartment of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).If you live in one of the following states, you may be eligible for assistance paying your employer health planpremiums. The following list of states is current as of January 31, 2024. Contact your State for more information oneligibility %u2013ALABAMA %u2013 Medicaid ALASKA %u2013 MedicaidWebsite: http://myalhipp.comPhone: 1-855-692-5447The AK Health Insurance Premium Payment ProgramWebsite: http://myakhipp.com/Phone: 1-866-251-4861Email: CustomerService@MyAKHIPP.comMedicaid Eligibility:https://health.alaska.gov/dpa/Pages/default.aspxARKANSAS %u2013 Medicaid CALIFORNIA %u2013 MedicaidWebsite: http://myarhipp.com/Phone: 1-855-MyARHIPP (855-692-7447)Health Insurance Premium Payment (HIPP) Program Website:http://dhcs.ca.gov/hippPhone: 916-445-8322Fax: 916-440-5676Email: hipp@dhcs.ca.govHIPAA Notice of Privacy Practices (cont.)