This notice is in effect as of May 30, 2003
Revised August 18, 2016
THIS NOTICE DESCRIBES HOW FINANCIAL AND HEALTH INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
- Statement of Our Duties
We are required by law to maintain the privacy of your personal financial and health information and to provide you with this notice of our privacy practices and legal duties. We are required to abide by the terms of this notice. We reserve the right to change the terms of this notice and to make any new provisions effective to all of the personal financial and health information that we maintain about you. If we revise this notice, we will provide you with a revised notice by mail.
- Statement of Your Rights
You have a right to know how we may use or disclose your personal financial and health information. This notice informs you of those uses and disclosures. There are certain uses and disclosures of your personal financial and health information that we are permitted or required to make by law without your permission. For all other uses and disclosures, we first must obtain your permission. In addition, you have the following rights:
- The right to request that we place additional restrictions on our uses and disclosures of your personal financial and health information, including the right to discontinuing any use of this information. This would be your request to “Opt Out”.
- The right to access, inspect and copy the protected information pertaining to you that we maintain in our files about you, and the right to have us correct or amend any information that we create in error. Requests to access or amend your personal financial and health information should be sent to the contact person and address provided in paragraph 8.
- The right to receive an accounting of the disclosures of your personal financial and health information that we make for purposes other than activities related to your treatment, or our payment functions or other health care operations.
- The right to request that you receive communications of personal financial and health information in a confidential manner.
- If you receive this notice on our web site or by electronic mail (e-mail) you are also entitled to receive this notice in paper form. To obtain a paper copy of this notice, contact us as described below.
- Information We Collect About You
We collect the following categories of information about you from the following sources:
- Examples of the type of information we collect include: Your name, address, date of birth, social security number, health information, drivers license number, credit history, or motor vehicle reports.
- Information that we obtain directly from you, in conversations or applications or other forms that you fill out.
- Information that we obtain as a result of our transactions with you.
- Information that we obtain from your medical records or from medical professionals.
- Information that we obtain from other entities, such as health care providers, financial
institutions or insurance companies in order to service your policy or carry out insurance
- Permissible Uses and Disclosure of Protected Information
- In Situations Permitted Or Required By Law.
- To Carry Out Operations Relating to All of Your Insurance, Including Employee Benefits. We may disclose the personal information we obtain about you as described above with other third parties for our normal business functions. Third parties include life insurers, health plans, disability insurers, stop loss insurers, health care providers or other health plans, financial institutions and other insurers. Examples of how we serve you in our normal business functions include:
- Marketing products or service;
- Processing applications for products or services;
- Assisting with claims;
- Administering contracts; and
- Processing transactions that you request.
- Complaints About Misuse of Health Information
You may complain either directly to us, the Division of Insurance or the Secretary of Health and Human Services if you believe that your rights with respect to our protection of your health information have been violated. To file a complaint with us, you may submit a complaint in writing that includes as may details as possible. You will not be retaliated against in any way for filing a complaint.
- Our Practices Regarding Confidentiality and Security
We restrict access to non-public personal financial and health information about you to those employees of ours who need to know that information in order to provide products or services to you. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your non-public personal financial and health information.
- Our Policy Regarding Dispute Resolution
- Contact Person for Filing a Complaint or Obtaining Further Information
Michael F. Combs, President
Combs Insurance Agency, Inc.
341 S. Alaska Street
Palmer, AK 99645