✓✓✓ ✓ ✓ NOTICE OF OUR INFORMATION PRIVACY POLICIES AND PRACTICES This notice is being provided on behalf of the following entities: 
Wellmark, Inc. doing business as Wellmark Blue Cross and Blue Shield of Iowa Wellmark of South Dakota, Inc. doing business as Wellmark Blue Cross and Blue Shield of South Dakota Wellmark Health Plan of Iowa, Inc. Midwest Benefit Consultants, Inc. 
To Our Customers: 
This notice informs you that we do not disclose to our nonaffiliated third parties your nonpublic personal financial information, which we collect and maintain as described below, except as permitted by law. We will not disclose your nonpublic personal financial information to nonaffiliated third parties even after our customer relationship may end, except as permitted by law. We do disclose, or we reserve the right to disclose, your nonpublic personal financial information we collect to our affiliates. The affiliated entities are bound by the practices described in this Notice. 
How we protect information: Except as explained below, we restrict access to your nonpublic personal information, which we define to include both nonpublic personal financial information and nonpublic personal health information, to our employees who need to know to provide our products and services to you and to nonaffiliated third parties providing services, at the request of Wellmark or its affiliate, related to the administration of your contract or policy with Wellmark or its affiliate. We maintain physical, electronic, and procedural safeguards that comply with legal requirements to guard your nonpublic personal information. 
Information we collect and maintain: We collect nonpublic personal financial information about you from the following sources: 
Information we receive from you on applications or other forms; Information we obtain from your transactions with us, our affiliates or others. 
Information we disclose: We disclose or reserve the right to disclose all of the nonpublic personal financial information we collect and maintain about you to our affiliates. Our affiliates include the financial service providers listed above. They operate as health insurers, a health maintenance organization (HMO) and an insurance brokerage. Our affiliates also include financial service providers such as a health insurer and third party administrators of employee benefit plans. 
We may also disclose, and reserve the right to disclose, any of your nonpublic personal financial information to nonaffiliated third parties as permitted by law. 
Companies that provide services or market for us: We may disclose any of your nonpublic personal financial information described above to the following categories of nonaffiliated third parties with which we contract to perform functions or services, such as marketing, on our behalf, and financial institutions with which we have joint marketing agreements: 
Insurance brokers and agents; Issuers of other insurance products such as life insurance, disability insurance, long-term care insurance; Administrative service providers which process and store membership information. 
No other disclosures to nonaffiliated third parties: We otherwise do not disclose nonpublic personal information about our customers or former customers to nonaffiliated third parties. 
M-53692 6/14 AN-T 
Required Federal Accessibility and Nondiscrimination Notice 
Discrimination is against the law Wellmark complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Wellmark does not exclude people or treat them differently because of their race, color, national origin, age, disability or sex. 
Wellmark provides: 
• Free aids and services to people with disabilities so they may communicate effectively with us, such as: 
• Qualified sign language interpreters 
• Written information in other formats (large print, audio, accessible electronic formats, other formats) 
• Free language services to people whose primary language is not English, such as: 
• Qualified interpreters 
• Information written in other languages If you need these services, call 800-524-9242. 
If you believe that Wellmark has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with: Wellmark Civil Rights Coordinator, 1331 Grand Avenue, Station 5W189, Des Moines, IA 50309-2901, 515-376-4500, TTY 888-781-4262, Fax 515-376-9073, Email CRC@Wellmark.com. You can file a grievance in person, by mail, fax or email. If you need help filing a grievance, the Wellmark Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail, phone or fax at: U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Room 509F, HHH Building, Washington DC 20201, 800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/ index.html. 
ATENCIÓN: Si habla español, los servicios de asistencia de idiomas se encuentran disponibles gratuitamente para usted. Comuníquese al 800-524-9242 o al (TTY: 888-781-4262). 
注意: 如果您说普通话, 我们可免费为您提供语言协助服务。 请拨打 800-524-9242 或 (听障专线: 888-781-4262)。 
CHÚ Ý: Nếu quý vị nói tiếng Việt, các dịch vụ hỗ trợ ngôn ngữ miễn phí có sẵn cho quý vị. Xin hãy liên hệ 800-524-9242 hoặc (TTY: 888-781-4262). 
NAPOMENA: Ako govorite hrvatski, dostupna Vam je besplatna podrška na Vašem jeziku. Kontaktirajte 800-524-9242 ili (tekstualni telefon za osobe oštećena sluha: 888-781-4262). 
ACHTUNG: Wenn Sie deutsch sprechen, stehen Ihnen kostenlose sprachliche Assistenzdienste zur Verfügung. Rufnummer: 800-524-9242 oder (TTY: 888-781-4262). 
مقرلاب لصتا .ةيناجملا ،ةيوغللا ةدعاسملا تامدخ كل رفون اننإف ،ةيبرعلا ةغللا ثدحتت تنك اذإ :هيبنت .(888-781-4262 : يصنلا فتاهلا ةمدخ( وأ 800-524-9242 
ສງຄວນເອາໃຈໃສ, ພາສາລາວ ຖາທານເວາ: ພວກເຮາມບລການຄວາມຊວຍເຫອດານພາ ສາໃຫທານໂດຍບເສຍຄາ ຫ 800-524-9242 ຕດຕທ. (TTY: 888-781-4262.) 
주의: 한국어 를 사용하시는 경우, 무료 언어 지원 서비스를 이용하실 수 있습니다. 800-524-9242번 또는 (TTY: 888-781-4262)번으로 연락해 주십시오. 
ध्यान रख : अगर आपकी भयाषया हिन्दी ि, तो आपक हिए भयाषया सिया्तया सवयाए, हनःशलक उपिब्ध ि। 800-524-9242 पर सपक कर ्या (TTY: 888-781-4262)। 
ATTENTION : si vous parlez français, des services d’assistance dans votre langue sont à votre disposition gratuitement. Appelez le 800 524 9242 (ou la ligne ATS au 888 781 4262). 
Geb Acht: Wann du Deitsch schwetze duscht, kannscht du Hilf in dei eegni Schprooch koschdefrei griege. Ruf 800-524-9242 odder (TTY: 888-781-4262) uff. 
โปรดทราบ: หากคณพด ไทย เรามบรการชวยเหลอดานภาษาสาหรบคณโดยไม คดคาใชจาย ตดตอ 800-524-9242 หรอ (TTY: 888-781-4262) 
PAG-UKULAN NG PANSIN: Kung Tagalog ang wikang ginagamit mo, may makukuha kang mga serbisyong tulong sa wika na walang bayad. Makipag-ugnayan sa 800-524-9242 o (TTY: 888-781-4262). 
w>'k;oh.ng=erh>uwdRunDusdm<usdmw>rRpXRw>zH;w>rRwz.<vXwb.vXmbl;vJ<td.vXe*D>vDRI qJ;usd;ql800=524=9242rhwrh>(TTY:888=781=4262)wuh>I 
ВНИМАНИЕ! Если ваш родной язык русский, вам могут быть предоставлены бесплатные переводческие услуги. Обращайтесь 800-524-9242 (телетайп: 888-781-4262(. 
सयाव्धयान: ्द् तपयाईं नपयािदी बोलनहुन्छ भन, तपयाईंकया ियाहग हन:शलक रूपमया भयाषया सिया्तया सवयािरू उपिब्ध गरयाइन्छ । 800-524-9242 वया (TTY: 888-781-4262) मया समपक गनिोस । 
ማሳሰቢያ፦ አማርኛ የሚናገሩ ከሆነ፣ የቋንቋ እገዛ አገልግሎቶች፣ ከክፍያ ነፃ፣ ያገኛሉ። በ 800-524-9242 ወይም (በTTY: 888-781-4262) ደውለው ያነጋግሩን። 
HEETINA To a wolwa Fulfulde laabi walliinde dow wolde, naa e njobdi, ene ngoodi ngam maaɗa. Heɓir 800-524-9242 malla (TTY: 888-781-4262). 
FUULEFFANNAA: Yo isin Oromiffaa, kan dubbattan taatan, tajaajiloonni gargaarsa afaanii, kaffaltii malee, isiniif ni jiru. 800-524-9242 yookin (TTY: 888-781-4262) quunnamaa. 
УВАГА! Якщо ви розмовляєте українською мовою, для вас доступні безкоштовні послуги мовної підтримки. Зателефонуйте за номером 800-524-9242 або (телетайп: 888-781-4262). 
Ge’: Diné k’ehj7 y1n7[ti’go n7k1 bizaad bee 1k1’ adoowo[, t’11 jiik’4, n1h0l=. Koj8’ h0lne’ 800-524-9242 doodaii’ (TTY: 888-781-4262) 
Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Health Plan of Iowa, Inc., Wellmark Synergy Health, Inc., Wellmark Value Health Plan, Inc. and Wellmark Blue Cross and Blue Shield of South Dakota are independent licensees of the Blue Cross and Blue Shield Association. 
M-2318376 08/16 A