Notice of Privacy Practices

Clever Care of Golden State Inc., a wholly owned subsidiary of Clever Care Health Plan, Inc. (herein referred to as Clever Care) is required by law to protect the privacy of your health information. We are required to provide you with this Notice of Privacy Practices, which explains how we may use information about you and when we can give out or “disclose” that information to others. You also have rights regarding your health information that is described in this notice. We are obligated to follow the terms outlined in this notice and to safeguard your health information in accordance with applicable federal and state privacy laws.

The terms “information” or “health information” in this notice include any information we maintain that reasonably can be used to identify you and that relates to your physical or mental health condition, the provision of health care to you, or the payment for such health care. We will comply with the requirements of applicable privacy laws related to notifying you in the event of a breach of your health information.

We have the right to change our privacy practices and the terms of this notice. If we make a material change to our privacy practices, we will provide you, in our next annual distribution, with a revised notice or information about the material change and how to obtain a revised notice.

We will provide you with this information either by direct mail or electronically, in accordance with applicable law. In all cases, if we maintain a website for your health plan, we will post the revised notice on your health plan website, clevercarehealthplan.com. We reserve the right to make any revised or changed notice effective for information we already have and for information that we receive in the future.

Clever Care collects and maintains oral, written, and electronic information to administer our business and to provide products, services, and information of importance to our enrollees. We maintain physical, electronic, and procedural security safeguards in the handling and maintenance of our enrollees’ information, in accordance with applicable state and federal standards, to protect against risks such as loss, destruction or misuse.

How We Use or Disclose Information

We must use and disclose your health information to provide that information:

To you or someone who has the legal right to act for you (your personal representative) in order to administer your rights as described in this notice; and

To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected.

We are permitted by law to use and disclose your protected health information (PHI) for purposes related to your treatment, payment for your health care and to operate our business. This includes sharing information with health care providers, pharmacies, and other entities involved in your care. For example, we may use or disclose your health information:

For Payment of premiums due us, to determine your coverage, and to process claims for health care services you receive, including for subrogation or coordination of other benefits you may have. For example, we may tell a doctor whether you are eligible for coverage and what percentage of the bill may be covered.

For Treatment. We may use or disclose health information to aid in your treatment or the coordination of your care. For example, we may disclose information to your physicians or hospitals to help them provide medical care to you.

For Health Care Operations. We may use or disclose health information as necessary to operate and manage our business activities related to providing and managing your health care coverage. For example, we might talk to your physician to suggest a disease management or wellness program that could help improve your health or we may analyze data to determine how we can improve our services. We may also de-identify health information in accordance with applicable laws. After that information is de-identified, the information is no longer subject to this notice, and we may use the information for any lawful purpose.

To Provide Your Information on Health-Related Programs or Products such as alternative medical treatments and programs or about health-related products and services, subject to limits imposed by law.

For Plan Sponsors. If your coverage is through an employer sponsored group health plan, we may share summary health information and enrollment and disenrollment information with the plan sponsor. In addition, we may share other health information with the plan sponsor for plan administration purposes if the plan sponsor agrees to special restrictions on its use and disclosure of the information in accordance with federal law.

For Underwriting Purposes. We may use or disclose your health information for underwriting purposes; however, we will not use or disclose your genetic information for such purposes.

For Reminders. We may use or disclose health information to send you reminders about your benefits or care, such as appointment reminders with providers who provide medical care to you.

We May Use or Disclose Your Health Information Under Limited Circumstances

As Required by Law — when required to do so by law.

To Persons Involved With Your Care — to a person involved in your care or who helps pay for your care, such as a family member, when you provide verbal agreement, written authorization, or when you agree or do not object.

For Public Health Activities — such as reporting or preventing disease outbreaks to a public health authority.

For Reporting Victims of Abuse, Neglect or Domestic Violence — to authorized government authorities, including social service or protective service agencies.

For Health Oversight Activities — to a health oversight agency for activities authorized by law, such as licensure, governmental audits, and fraud/abuse investigations.

For Judicial or Administrative Proceedings — such as in response to a court order, search warrant, or subpoena.

For Law Enforcement Purposes — to a law enforcement official for purposes such as providing limited information to locate a missing person or report a crime.

To Avoid a Serious Threat to Health or Safety — to you, another person, or the public, by disclosing to public health agencies, law enforcement authorities, or in emergencies or natural disasters.

For Specialized Government Functions — such as military and veteran activities, national security and intelligence activities, and protective services for the President and others.

For Workers’ Compensation — as authorized by or necessary to comply with state workers compensation laws.

For Research Purposes — such as research related to evaluation of treatments or prevention of disease or disability.

To Provide Information Regarding Decedents — to a coroner or medical examiner to identify a deceased person or determine cause of death.

For Organ Procurement Purposes — to entities handling procurement, banking, or transplantation of organs, eyes, or tissue.

To Correctional Institutions or Law Enforcement Officials — if you are an inmate or under custody, only if necessary for health care provision, protecting health and safety, or safety of the correctional institution.

To Business Associates — that perform functions on behalf of Clever Care or provide services, if the information is necessary.

Additional Restrictions on Use and Disclosure

Certain federal and state laws may require special privacy protections restricting use and disclosure of certain health information, including:

• Alcohol and Substance Abuse
• Biometric Information
• Child or Adult Abuse or Neglect, including Sexual Assault
• Communicable Diseases
• Genetic Information
• HIV/AIDS
• Mental Health
• Minors’ Information
• Prescriptions
• Reproductive Health
• Sexually Transmitted Diseases

If any use or disclosure described in this notice is prohibited or materially limited by other applicable laws, we intend to meet the requirements of the more stringent law.

Except for uses and disclosures described and limited in this notice, we will use and disclose health information only with written authorization. You may revoke written authorization at any time in writing, except if we have already acted on it.

Our Responsibility

We are legally obligated to maintain the privacy and security of protected health information. If a breach occurs that may have compromised privacy or security, we will notify you promptly as required by law. We must adhere to the duties and privacy practices in this notice and provide a copy upon request.

Confidentiality of Substance Use Disorder (SUD) Records

Clever Care is required by federal law, including 42 U.S.C. § 290dd-2 and 42 CFR Part 2, to protect the privacy of any SUD treatment records we maintain or receive. These laws provide heightened confidentiality protections for SUD information.

How We May Use or Disclose SUD Information — Federal law strictly limits how SUD information may be used or disclosed. We may only use or disclose SUD treatment records in ways permitted by 42 CFR Part 2 or as authorized by written consent.

Prohibition on Re-Disclosure — Any SUD information identifying you as having received substance use disorder diagnosis, treatment, or referral is protected by federal law. Federal law prohibits anyone receiving this information from redisclosing it unless you provide written consent or federal law expressly allows it.

Your Rights Regarding SUD Information:

• The right to receive this notice explaining how SUD records may be used and disclosed.
• The right to request restrictions on disclosures of SUD information.
• The right to request an accounting of certain disclosures of SUD information.
• The right to file a complaint if privacy rights under federal law have been violated.

What Are Your Rights

Right to request restrictions — You may ask to restrict uses or disclosures for treatment, payment, or health care operations, and restrict disclosures to family members or others involved in your care or payment.

Right to confidential communications — You may ask to receive communications in a different manner or at a different place (e.g., sending information to a P.O. Box instead of your home).

Right to access and copy — You may see and obtain copies of certain health information such as claims, case, or medical management records. If maintained electronically, you may request an electronic copy.

Right to amend — You may ask to amend certain health information if you believe it is wrong or incomplete. Requests must be in writing with reasons for the amendment.

Right to an accounting of disclosures — You may receive an accounting of certain disclosures made during the six years prior to your request.

Right to a paper copy of this notice — You may request a paper copy at any time, even if you agreed to receive it electronically.

Exercising Your Rights

For questions about this notice or exercising your rights, call the toll-free member phone number on your health plan ID card or contact Member Services toll-free at 1-833-388-8168 (TTY: 711), 8 am to 8 pm, seven days a week, October 1 through March 31, and 8 am to 8 pm, weekdays, April 1 through September 30.

Mail written requests to:
Clever Care Health Plan
Attn: Privacy Officer
7711 Center Ave., Suite 100
Huntington Beach, CA 92647

Or submit by email to: compliance@ccmapd.com

Filing a Complaint — If you believe your privacy rights have been violated, you may file a complaint at the address above. You may also notify the Secretary of the U.S. Department of Health and Human Services. We are prohibited by law from retaliating for filing a complaint.

Financial Information Privacy Notice

Clever Care is committed to maintaining the confidentiality of personal financial information. “Personal financial information” means information about an enrollee or applicant that identifies the individual, is not generally publicly available, and is collected from the individual or obtained in connection with providing health care coverage.

Information We Collect — Depending on the product or service, we may collect non-public personal financial information from:

• Information from applications or other forms, such as name, address, age, medical information, and Social Security number.
• Information about transactions with us, our affiliates, or others, such as premium payment and claims history.
• Information from a consumer reporting agency.

Disclosure of Information — We do not disclose personal financial information about enrollees or former enrollees to non-affiliated third parties, except as required or permitted by law.

Confidentiality and Security — We maintain physical, electronic, and procedural safeguards per applicable state and federal standards to protect personal financial information.

Questions About this Notice — Call the toll-free member phone number on your health plan ID card or contact Member Services toll-free at 1-833-388-8168 (TTY: 711).

This page was last updated on May 1, 2026.