Spouse And Dependent Authorization

Before you enroll in virtual second opinion consultations, we would like to provide you with some information about the health information we may ask for from you, how and why we use it, and how we protect it. You are not required to participate in this program. Participation is completely voluntary. However, if you choose to participate, you may receive incentives and/or information on services to help you manage your health. If you choose not to participate, you may not receive program incentives, if any, offered by your health plan for participation in such second opinion programs.

What information do we obtain?

• Our virtual second opinion consultations ask questions about your health status and conditions, health-related activities and behaviors. Our consultants may also collect and review your medical records.
• How do we use your information? Information provided to us as part of the virtual second opinion consultations may be used to help us provide you with feedback and educational information about your diagnosis and treatment options, to help you in your journey to better manage your health.

How do we share and protect your information?

• The health information you give us as part of a health and wellness program or second opinion consultation is generally not shared with your spouse's/parent's employer, although we may share certain information (e.g., the amount of incentives earned), as necessary where their employer or their designated third party vendor is administering incentive awards. We will share information with our wellness coaches, nurses, and doctors, whom are involved in administering your wellness and condition management programs and health plan. We only share information with our vendors and subcontractors in accordance with applicable laws, including HIPAA, as necessary to administer your wellness and condition management programs or health plan, and anyone who receives information from us for purposes of providing you services is required to abide by the same confidentiality requirements.
• We take reasonable precautions to protect data and to avoid data breaches, including maintaining physical, technical, and administrative safeguards. Such safeguards may include, for example, firewalls, encryption, identity management, and intrusion prevention/detection to prevent improper access, use, and disclosure of your data in our networks. In the event of a data breach involving information you provide in connection with the wellness program, we will notify you within the time periods required by applicable laws, including HIPAA.

For a written authorization:

By checking the box/clicking "I Accept"/signing below:

• I on behalf of [myself/minor child] affirm that I have read and understood this authorization;
• On behalf of [myself/minor child], I am intending to electronically sign this authorization;
• I on behalf of [myself/minor child] understand that participation in any programs noted above is completely voluntary; and
• I on behalf of [myself/minor child] agree that if I choose to participate in any programs noted above, I authorize the collection and use of my data as described in this authorization