Notice of privacy practices

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information.

Effective: Feb. 16, 2026

Our responsibilities

Sharp Health Plan provides health care coverage to you. We receive information about you when you become eligible and enroll in our health plan. We understand that information about you and your health is confidential. We are committed to protecting the privacy of this information. Federal and California laws make us responsible for protecting the privacy of your health information. This Notice explains your privacy rights regarding Protected Health Information (“Health Information”) and outlines Sharp HealthCare's (“Sharp's”) responsibilities for using and disclosing it. We must provide you with this Notice of Privacy Practices and follow the terms of the Notice currently in effect. We will notify you if a breach of your Health Information occurs, and we will not share your Health Information without your written permission, except as described below.

Changes to this Notice: We have the right to change the privacy practices described in this Notice. If we do make changes, the new Notice will be available upon request, in our office, and on our website at sharphealthplan.com/privacy-practices.

How we may use and disclose your health information

As a health plan, we perform activities such as verifying eligibility and enrollment, approving and paying for health care services, investigating fraud, evaluating the quality of care that you receive, and coordinating your benefits. Federal and California law permit us to use and disclose your Health Information without your written authorization only in specific circumstances described below. The following categories describe different ways that we typically use or share your Health Information.

How we use your contact information

We use your contact information to help manage your care and coverage. This may include:

• Providing authorization for care
• Updating you about your care or care options
• Working with you on payment arrangement

We may use automated calls or prerecorded messages when contacting you.

Treatment: We may share your Health Information with health care providers to help you receive the care you need. You may need medical treatment that requires us to approve care in advance. For example, when you require medical treatment that needs preauthorization, we provide information to doctors, hospitals, or other providers so they can deliver appropriate care.

Payment: We use and disclose Health Information to review, approve, process and pay health care claims sent to us for your medical care. For example, Health Information may be shared with the doctors, clinics, or others who submit claims to us for payment. We may also forward Health Information to other health plans or organizations when necessary for payment.

Health Care Operations: We may use information in your health plan record to assess the quality of the health care you receive. For example, Health Information may be used in audits, fraud, waste and abuse programs, care coordination, planning, and other administrative activities. Sharp Health Plan does not use or disclose genetic information for underwriting purposes.

Business Associates: We may disclose your Health Information to our contractors so that they can assist us in providing care and services. To protect your Health Information, we require these business associates to sign a written agreement to safeguard your Health Information.

Telecommunications Relay Services (TRS): TRS may be used to facilitate phone calls for individuals who are deaf, hard of hearing, deaf-blind or have a speech disability. TRS facilitates such calls by using a communications assistant who interprets conversations.

Improving Our Services: We may use information about you, if the law allows it, to help us improve our services or develop new ones. For example, we may use patterns in health plan records to give clinicians better tools to support their decisions.

How else can we use or share your health information?

We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html.

Lawsuits and Disputes: If you are involved in a lawsuit, dispute, investigation, or other legal proceeding, we may use or disclose your Health Information only as required or permitted by applicable federal and California law. We may disclose Health Information in response to a valid order of a California state court, a federal court, or an administrative tribunal with lawful authority, and only to the extent authorized by such order and applicable law.

We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process only when all applicable legal requirements have been satisfied, and the disclosure is otherwise permitted by law.

Notwithstanding the foregoing, we will not disclose, provide access to, transmit, transfer, share, or otherwise release medical information relating to an individual seeking, obtaining, providing, supporting, or assisting with reproductive health care, abortion or abortion-related services, contraception, gender-affirming health care, gender-affirming mental health care, or other legally protected health care activities that are lawful in California when the request, subpoena, inquiry, investigation, or legal process is based on, seeks to enforce, or arises from another state's law that interferes with or restricts rights protected under California law, except as expressly required by federal law or otherwise authorized under applicable California law.

We also will not cooperate with an inquiry or investigation from another state, or, to the extent permitted by federal law, from a federal agency, that seeks information that would identify an individual in connection with legally protected health care activities that are lawful in California, except as expressly authorized or required by applicable law.

Substance use disorder (SUD) records have extra protections. They can only be used or shared for these purposes after you are given notice and a chance to be heard. A court order that allows the use or sharing of SUD records must also include a subpoena or similar legal mandate that requires the records to be disclosed before they can be used or shared.

California Limits on Subpoena Responses for Sensitive Services: California law prohibits us from releasing medical information related to a person seeking or obtaining (i) an abortion or abortion-related services that are lawful in California, (ii) gender-affirming health care or gender-affirming mental health care that is lawful in California, or (iii) contraception, in response to a subpoena, request, or law-enforcement inquiry that is based on another state’s laws that interfere with such care or on a foreign penal civil action. We also will not cooperate with any inquiry or investigation from another state, or, to the extent permitted by federal law, from a federal agency, that would identify an individual and is related to such services.

Appeals of Health Care Decisions: You or your health care providers may appeal decisions about your health care claims. Your Health Information may be used during these appeal processes.

Legal Requirements

We will disclose Health Information about you without your permission when required to do so by applicable federal or California law. We may use or disclose Health Information about you:

• For workers' compensation claims
• For law enforcement purposes or with a law enforcement official, as permitted or required by law. However, California law prohibits us from releasing medical information that would identify an individual seeking, obtaining, providing, supporting, or assisting with abortion, abortion-related services, contraception, gender-affirming health care, gender-affirming mental health care, or other legally protected health care activities that are lawful in California when the request is based upon another state's law that interferes with those rights or for the enforcement of a foreign penal or civil action, except as otherwise authorized or required by applicable law.
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security and presidential protective services
• In response to a court order, subpoena, discovery request, administrative request, or other lawful process, but only when permitted by applicable federal and California law and all legal requirements have been satisfied. We will not disclose protected reproductive, sexual, or gender-affirming health information in response to requests that California law prohibits us from honoring.

California Protections for Legally Protected Health Care Activities

Notwithstanding any other provision of this Notice, we will not knowingly disclose, transmit, transfer, share, provide access to, or otherwise release medical information that would identify an individual seeking, obtaining, providing, supporting, or assisting in legally protected health care activities that are lawful in California, including abortion, abortion-related services, contraception, gender-affirming health care, and gender-affirming mental health care, when California law prohibits such disclosure. We also will not cooperate with an inquiry or investigation from another state, or, to the extent permitted by federal law, from a federal agency, that seeks information identifying an individual in connection with such legally protected health care activities, except as expressly authorized or required by applicable law.

We Will Not Disclose Health Information About You Without Your Permission Unless as Described Below:

• Emergency Situations: We may disclose information about you, including substance use disorder information when permitted by applicable law, as necessary to respond to declared emergencies, natural disasters, serious disruptions to treatment facilities or services, public health emergencies, or medical emergencies.
• Employer Disclosures: We provide employers only the Health Information permitted by law, such as summary health information, enrollment and disenrollment information, premium and billing information, and other information authorized by federal and California law. We do not disclose individually identifiable medical information to employers unless authorized or required by law.

California Sensitive Services Protections

California law provides heightened protections for medical information related to certain sensitive services, including abortion and abortion-related services, gender-affirming health care and gender-affirming mental health care, contraception, reproductive and sexual health services, and substance use disorder treatment. For these services, the following additional protections apply:

• Out-of-State Subpoenas and Inquiries. We will not release medical information related to a person seeking or obtaining an abortion, gender-affirming care, or contraception that is lawful in California in response to a subpoena, request, or law-enforcement inquiry that is based on another state’s laws that interfere with such care or on a foreign penal civil action. We will not cooperate with any inquiry or investigation from another state, or, to the extent permitted by federal law, from a federal agency, that would identify an individual and is related to such services.
• Electronic Records and Health Information Exchanges. California law generally prohibits us from knowingly disclosing or transmitting medical information about a person seeking, obtaining, providing, supporting, or aiding a lawful California abortion through an electronic health record system or health information exchange to any individual or entity in another state, except under specific conditions, including a valid written authorization that expressly covers abortion-related information.
• Data Exchange Framework. Information related to abortion, abortion-related services, gender-affirming care, and contraception is excluded from automatic sharing through the California Health and Human Services Data Exchange Framework.
• Storage and Access Safeguards. Where applicable, we require our vendors and business associates that electronically store sensitive-services information on our behalf to limit access privileges, segregate such information from the rest of the medical record, and prevent disclosure to persons or entities outside California, consistent with California law.

Situations requiring your written authorization

If we ever need to use and disclose your Health Information for any reason not described in this Notice, we will first obtain your written permission. If you give us this permission, you may take it back at any time by telling us in writing. Please understand that we cannot take back any disclosures we have already made with your permission. Examples of disclosures that require your authorization include:

Substance Use Disorder Records: We maintain additional protections for Health Information related to substance use disorder (SUD) diagnosis, treatment, or referral for treatment as required by law. These records are kept confidential and cannot be disclosed without your written consent, except in limited situations allowed by law, such as a medical emergency or when required for specific health plan operations. You can give one consent for all future uses or disclosures of your SUD information for treatment, payment, and health care operations. This means that once you provide the consent, your SUD records can be used and disclosed without asking you again as permitted by law, unless you revoke your consent in writing.

Sensitive Services: You have the right to receive Sensitive Services or to submit a claim for Sensitive Services if you have the right to consent to care.

• You have the right, without the authorization of the Subscriber or another policyholder, to have communications containing medical information related to Sensitive Services communicated to you at an alternative mail or email address or telephone number. You can update your contact information in your Sharp Health Plan account or by contacting Customer Care at 1-800-359-2002.
• If you have not designated an alternative mailing address, email address, or telephone number, we will send or make all communications related to your receipt of Sensitive Services in your name at the address or telephone number on file. Such communications include written, verbal, or electronic communications, including:
  • Bills and attempts to collect payment.
  • A notice of adverse benefits determinations.
  • An explanation of benefits notice.
  • A health care service plan's request for additional information regarding a claim.
  • A notice of a contested claim.
  • The name and address of a provider, description of services provided, and other information related to a visit.
  • Any written, oral, or electronic communication from a health care service plan that contains protected health information.
• We will not disclose medical information related to your receipt of Sensitive Services to the policyholder, primary subscriber, or any plan enrollees, absent your express written authorization.
• You have the right to request confidential communication in a certain form and format if it is readily producible in the requested form and format, or at alternative locations. The confidential communication request shall be valid until you submit a revocation of the request or a new confidential communication request is submitted.

Potential for Redisclosure: Health Information disclosed under this Notice or under your authorization may be redisclosed by the recipient and may lose protection under the privacy laws, except that California law restricts the redisclosure and cross-state electronic transmission of certain sensitive-services information as described in the “California Sensitive Services Protections” section of this Notice.

Your rights regarding your health information

Important: Sharp Health Plan does not maintain copies of your medical records. If you would like to access, obtain copies, or request changes to your medical records, please contact your doctor, medical group, or clinic directly.

You may contact Customer Care at 800-359-2002 to obtain additional information and instructions for exercising the following rights:

Right to Inspect and Copy: You can request an electronic or paper copy or a summary/explanation of your health plan records. We will provide a copy or a summary of your Health Information within 15 business days of your request.

Right to Request Restrictions: You can ask us not to use or share your Health Information in the ways described in this notice. While we will consider all requests, we may not be able to agree to your restriction. If you pay for a service or a health care item out-of-pocket in full, you can ask your provider not to share that information with us or with other health insurers.

Right to Request Confidential Communications: You have the right to ask us to communicate with you about your Health Information by alternative means or at an alternative location. Under California law, we will accommodate your request when you state either that the communication discloses medical information related to your receipt of sensitive services (such as abortion or abortion-related services, gender-affirming care, contraception, reproductive and sexual health services, mental or behavioral health, sexually transmitted infections, substance use disorder, or services related to intimate partner violence) or that disclosure of all or part of the medical information could endanger you. We will not require you to explain the basis for any endangerment statement.

Your request must be made in writing, telephonic or by electronic transmission and must include a statement that the request relates to sensitive services or that disclosure could endanger you. Your request will remain valid until you submit a revocation or a new request. We will implement your request within seven (7) calendar days of receipt of an electronic transmission or telephonic request, or within fourteen (14) calendar days of receipt by first-class mail. We will acknowledge receipt and advise you of the implementation status if you contact us. We will not condition your enrollment or coverage on the waiver of these rights. To make a request, contact Customer Care at 1-800-359-2002 or write to the address listed at the end of this Notice.

Right to Amend: You may request a correction to your Health Information that you think is incorrect or incomplete. We may deny your request if:

• The information is not created or kept by Sharp Health Plan, or
• We believe it is correct and complete.

If your request is denied, you may ask for a review of our decision. You may also submit a written statement saying why you disagree with our records, and that statement will be kept with your records.

Right to a Statement of Disagreement: If we deny your request to amend your Health Information, you have the right to submit a written statement disagreeing with the denial. Your statement will be included with the disputed information and will accompany any future disclosure of that information. We will provide you with a copy of our denial and instructions for submitting a statement of disagreement upon request.

Right to an Accounting of Disclosures: You can ask for a list (accounting) of the times we've shared your Health Information, who we shared it with, and why. The accounting will be provided for three (3) years prior to the date of the request for electronic records, and six (6) years prior to the date of request for non-electronic records. We will not include disclosures for treatment, payment, health care operations, and certain other permitted disclosures.

Disclosures of substance use disorder (SUD) records made for treatment, payment and health care operations will be included in an accounting of disclosures for electronic records only.

Right to a Copy of This Notice: You have a right to request a copy of this Notice of Privacy Practices. You also can find this Notice on our website at: sharphealthplan.com/privacy-practices.

How we collect, use, and safeguard your health information

Sources of Information. We collect Health Information from various sources, including: information you provide on enrollment forms and in communications with us; information from your health care providers (such as doctors, hospitals, medical groups, and pharmacies); information from claims and authorization requests submitted on your behalf; information from other health plans or insurers in connection with coordination of benefits; information from our business associates and contractors; and information from federal, state, and local government programs and agencies as permitted by law.

Internal Use of Information. Within Sharp Health Plan, access to your Health Information is limited to those workforce members and contractors who need the information to perform their duties, such as eligibility verification, care coordination, claims processing, customer service, quality assessment, fraud prevention, and compliance functions. Information related to sensitive services is subject to additional access controls as described in the “California Sensitive Services Protections” section of this Notice.

Safeguards. We maintain administrative, physical, and technical safeguards designed to protect your Health Information from unauthorized access, use, or disclosure. These safeguards include, where applicable: workforce training and confidentiality agreements; role-based access controls and audit logging; physical security of facilities and records; encryption and other technical security measures; written agreements with our business associates requiring them to safeguard your Health Information; and policies and procedures developed pursuant California law governing the creation, maintenance, storage, and disposal of medical information.

Complaints regarding your privacy rights

If you believe that we have not protected your privacy and you wish to file a complaint (also called a grievance), you may contact any of the following without fear of retaliation:

Sharp HealthCare

• Mail: Privacy Officer, 8695 Spectrum Center Blvd, San Diego, CA 92123
• Phone: Call us at 858-499-3138
• Email: privacy@sharp.com

U.S. Department of Health and Human Services, Office for Civil Rights (OCR)

• Mail: Office for Civil Rights, U.S. Department of Health & Human Services
  200 Independence Avenue, S.W., Washington, D.C. 20201
• Phone: 1-877-696-6775
• Online: www.hhs.gov/ocr/privacy/hipaa/complaints/

Sharp Direct Advantage is offered by Sharp Health Plan. Sharp Health Plan is an HMO with a Medicare contract. Enrollment with Sharp Health Plan depends on contract renewal. Read the full disclaimer.

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