Electronic Disclosure and Consent in Profile

With your consent, Independent Health Association, Inc., its affiliates, subsidiaries, and their respective agents (collectively, “Independent Health”) will provide you with electronic copies of those documents you have selected in the [“Preferences” page (collectively, the “Electronic Documents”) found on the IndependentHealth.com member portal (the “Member Portal”).    By opting-in to receive the Electronic Documents you have selected within the Preferences section of your Member Portal profile, you agree to receive such Electronic Documents electronically from Independent Health in lieu of paper copies of such documents (the “Electronic Delivery Service”).  This consent shall remain in effect until changed as described in Sections 2 or 3 below.

1. Description of Electronic Delivery Service. Each time a new Electronic Document is delivered electronically to your Member Portal, you'll be notified through your email that you have a secure message in your Member Portal account letting you know an Electronic Document is ready for your review. You may view your Electronic Document by logging into your secure Member Portal account and navigating to your documents.
2. Change in Preference/Withdrawal of Consent.  You may withdraw your consent to electronic delivery of Electronic Documents and resume paper delivery of such documents at any time and without charge through your Member Portal or by contacting member services:
   
   • Medicare members can contact Independent Health at (716) 250-4401 or 1-800-665-1502 (TTY: 711), Oct. 1 – Mar 31: Monday - Sunday, 8 a.m. - 8 p.m., Apr. 1 – Sept. 30: Monday - Friday, 8 a.m. - 8 p.m.
   • Other members can contact Independent Health at (716) 631-8701 or 1-800-501-3439
   If you change your preference, or can no longer access your Member Portal based on your account status. , paper delivery will resume within a reasonable time (not to exceed 30 days) after the change is made.
3. Undeliverable Emails. To receive Electronic Documents, you must maintain a verified email address on file with Independent Health to continue to receive Electronic Documents..To ensure that you continue to receive emails from us, add the email “from” address to your email address book or safe list. To update your email address, log in to your Independent Health Member Portal, navigate to your profile and click on the contact information section. If we attempt to deliver information to an email address you provide, and the message is returned as undeliverable, we will assume that you have withdrawn consent for electronic delivery and will begin sending the information to you in paper format
4. System Requirements. In order to access, view, print and retain Electronic Documents delivered via the Electronic Delivery Service, you must first enroll in Independent Health’s Digital Services by creating an account from either the MyIH mobile application, or on our website. In addition to maintaining your Digital Services account, you must have, at your own expense, the following:
   1. Access to a computer or other device that is capable of accessing the Internet. Your access to this page verifies that your system/device meets this requirement;
   2. An Internet web browser which is capable of supporting 128-bit encryption communications or higher;
   3. An email account, an Internet service provider, and email software;
   4. Software which permits you to access, view and retain Portable Document Format or “PDF” files, such as a current version of Adobe Acrobat Reader® (which you can download at http://get.adobe.com/reader); and
   5. To print Electronic Documents, you must have a printer connected to your device.
5. Incorporation of Digital Services Terms and Conditions.  This Electronic Document Disclosure is incorporated into and supplemented by the terms and conditions applicable to your use of the Independent Health Digital Services.

Rev 5/2022

Y0042_C8320_C