Effective Date: May 30, 2003

Last Revised: August 18, 2016

THIS NOTICE DESCRIBES HOW FINANCIAL AND HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. Our Legal Duties

We are required by law to maintain the privacy of your personal financial and health information and to provide you with notice of our legal duties and privacy practices.

We are required to follow the terms of this notice currently in effect. We reserve the right to change the terms of this notice and to make any revised provisions effective for all personal financial and health information we maintain about you. If we revise this notice, we will provide you with a revised copy by mail.

2. Your Rights

You have the right to understand how we may use or disclose your personal financial and health information. Certain uses and disclosures are permitted or required by law without your authorization. For all other uses and disclosures, we must obtain your permission.

You also have the following rights:

• Right to Request Restrictions: You may request additional restrictions on how we use or disclose your personal financial and health information, including requesting that we discontinue certain uses (“Opt Out”).

• Right to Access and Amend: You may access, inspect, and obtain copies of the protected information we maintain about you. You may also request corrections or amendments to information we have created in error. Requests should be submitted to the contact person listed below.

• Right to an Accounting of Disclosures: You may request a record of disclosures of your personal financial and health information made for purposes other than treatment, payment, or healthcare operations.

• Right to Confidential Communications: You may request that communications regarding your personal financial and health information be provided in a confidential manner.

• Right to a Paper Copy: If you receive this notice electronically, you are entitled to request and receive a paper copy.

3. Information We Collect

We collect personal financial and health information about you from various sources, including:

• Information you provide directly to us through applications, forms, and conversations

• Information obtained through transactions between you and our agency

• Information from medical records or medical professionals

• Information from third parties such as healthcare providers, financial institutions, insurance companies, or other insurers

Examples of information we may collect include:

• Name, address, and date of birth

• Social Security number

• Driver’s license number

• Health information

• Credit history or motor vehicle reports

4. Permissible Uses and Disclosures

We may use or disclose your personal financial and health information in situations permitted or required by law.

We may also disclose information to carry out operations relating to your insurance coverage, including employee benefits. Third parties may include life insurers, health plans, disability insurers, stop loss insurers, healthcare providers, financial institutions, and other insurers.

Examples of business functions include:

• Marketing products or services

• Processing applications

• Assisting with claims

• Administering contracts

• Processing requested transactions

5. Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

• Our office

• The Division of Insurance

• The Secretary of Health and Human Services

Complaints to our office should be submitted in writing and should include as much detail as possible. You will not be retaliated against for filing a complaint.

6. Confidentiality and Security

We restrict access to non-public personal financial and health information to employees who need access in order to provide products or services to you.

We maintain physical, electronic, and procedural safeguards that comply with federal regulations to protect your non-public personal financial and health information.

7. Dispute Resolution

Any controversy or claim arising out of or relating to this Privacy Policy, or the breach thereof, shall be settled by binding arbitration in accordance with the rules of the American Arbitration Association. Judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction.

8. Contact Information

If you have questions, wish to exercise your rights, or would like to file a complaint, please contact:

Michael F. Combs, President

Combs Insurance Agency, Inc.

341 S. Alaska Street

Palmer, AK 99645

Phone: (907) 745-2144