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SUMMARY PLAN DOCUMENT AND

- i - SUMMARY plan DOCUMENT AND SCHEDULE OF benefits FOR missouri department OF transportation AND missouri STATE HIGHWAY PATROL medical AND life INSURANCE plan - ii - Member HIPAA Notification missouri department of transportation and missouri State Highway Patrol medical and life Insurance plan Your Privacy Matters In compliance with the Health Insurance Portability and Accountability Act (HIPAA), missouri department of transportation (MoDOT) and missouri State Highway Patrol (MSHP) medical and life Insurance plan ( plan ) is sending you important information about how your medical and personal information may be used and about how you can access this information. Please review the Notice of Privacy Practices carefully. If you have any questions, please call the Participant Services number on the back of your membership identification card. You may also contact the designated privacy officer. The privacy officer for our plan is Jeff Padgett, Director of Risk and benefits Management, MoDOT, Box 270, Jefferson City, MO 65102.

- i - summary plan document and schedule of benefits for missouri department of transportation and missouri state highway patrol medical and life insurance plan

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