PURPOSE OF THIS NOTICE
Title V of the Gramm- Leach-Bliley Act (GLBA) and the laws of the State(s) of Ohio, Indiana, Michigan, Pennsylvania, Kentucky, Tennessee, Wisconsin, and Arizona, generally prohibit us from sharing nonpublic personal information about you with a third party unless we provide you with this notice of our privacy policies and practices describing the type of information that we collect about you and the categories of persons or entities to whom that information may be disclosed. In compliance with the GLBA and applicable State laws, we are providing you with this document, which notifies you of the privacy policies and practices of Leland Smith Insurance Services, Inc., referred to in the rest of this document as “LSI”.
OUR PRIVACY POLICIES AND PRACTICES
1. Information we collect:
A. Categories of Information Collected and Sources from Which We Collect It.
We collect nonpublic personal information about you from the following sources: Information we receive from you on applications other forms. Information about your transactions with us, our affiliates or others. Information we receive from a consumer reporting agency. Information we receive from medical records or medical professionals.
B. Persons From Whom Information is Collected
We may collect nonpublic personal information from individuals other than those proposed for coverage.
C. Information From Credit Reports or Investigative Consumer Reports
We may obtain information about you from credit reports or other investigative consumer reports prepared by third parties at our request. You have the right to request to be interviewed in connection with the preparation of such a report. Upon request, you are entitled to receive a copy of the report. The information obtained from the report prepared by the third party may be retained by the third party and disclosed to other persons.
2. Information we may disclose to third parties: In the course of our general business practices, we may disclose the information that we collect (as described above) about you or others without your permission to the following types of institutions for the reasons described:
To a third party if the disclosure will enable that party to perform a business, professional or insurance related function for us;
To an insurance institution, agent, or credit reporting agency in
order to detect or prevent criminal activity, fraud or misrepresentation in connection with an insurance transaction;
To a lending institution in connection with liens against property that you insure with us;
To an insurance institution, agent, or credit reporting agency for either this agency or the entity to whom we disclose the information to perform a function in connection with an insurance transaction involving you;
To a medical care institution or medical professional in order to verify coverage or benefits, inform you of a medical problem of which you may not be aware, facilitate the payment of a claim, or conduct an audit that would enable us to verify treatment;
To an insurance regulatory authority, law enforcement, or other governmental authority in order to protect our interests in preventing or prosecuting fraud, or if we believe that you have conducted illegal activities;
To a group policyholder for the purpose of reporting claims experience or conducting an audit of our operations or services;
In addition to those circumstances listed above, and unless you tell us not to, we may disclose certain information about you to third parties whose only use of the information will be for purposes of marketing a product or service. Under no circumstances will we disclose for marketing purposes any medical information; information relating to a claim for benefit or, a civil or criminal proceeding involving you; or personal information relating to your character, personal habits, mode of living or general reputation.
3. Third parties with whom we share certain information protected by the Fair Credit Reporting Act, unless you tell us not to:
A: Information we obtain from your insurance application, such as your income or your marital status; Information we obtain from a consumer report, such your credit score or credit history; Information we obtain from a person regarding its employment, credit, or other relationship with you, such as your employment history.
B. Third party companies who may receive this information are:
Financial service providers, such as: insurance companies, investment brokerage companies.
C. If you prefer that we not share this information with third party companies, you may direct us not to share this information by doing the following:
4. Your right to access and amend your personal information: You have the right to request access to the personal information that we record about you. Your right includes the right to know the source of the information and the identity of the persons, institutions or types of institutions to whom we have disclosed such information within 2 years prior to your request. Your right includes the right to view such information and copy it in person, or request that a copy of it be sent to you by mail (for which we may charge you a reasonable fee to cover our costs). Your right also includes the right to request corrections, amendments or deletions of any information in our possession. The procedures that you must follow to request access to or an amendment of your information are as follows:
To obtain access to your information: You should submit a request in writing to: Randy Myers, Leland Smith Insurance Services, 1175 Westwood Dr, Ste 200, Van Wert, OH 45891. The request should include your name, address, social security number, telephone number, and the recorded information to which you would like access. The request should state whether you would like access in person or a copy of the information sent to you by mail. Upon receipt of your request, we will contact you within 30 business days to arrange providing you with access in person or the copies that you have requested.
To correct, amend, or delete any of your information: You should submit a request in writing to: Randy Myers, Leland Smith Insurance Services, 1175 Westwood Dr, Ste 200, Van Wert, OH 45891. The request should include your name, address, social security number, telephone number, the specific information in dispute, and the identity of document or record that contains the disputed information. Upon receipt of your request, we will contact you within 30 business days to notify you either that we have made the correction, amendment or deletion, or that we refuse to do so and the reasons for the refusal, which you will have an opportunity to challenge.
5. Our practices regarding information confidentiality and security: We restrict access to nonpublic personal information about you to those employees 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 nonpublic personal information.
7. Reservation of the right to disclose information in unforeseen circumstances: In connection with the potential sale or transfer of its interests, LSI and its affiliates reserves the right to sell or transfer your information (including but not limited to your address, name, age, sex, zip code, state and country of residency and other information that you provide through other communications) to a third party entity that (1) concentrates its business in a similar practice or service; (2) agrees to be LSI’s successor in interest with regard to the maintenance and protection of the information collected; and (3) agrees to the obligations of this privacy statement.
THE REMAINDER OF THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW TO OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. Statement of Our Duties
We are required by the Health Insurance Portability and Accountability Act of 1996 to maintain the privacy of your personal 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 health information that we maintain about you. If we revise this notice, we will provide you with a revised notice in the following manner via US Mail or through your employer.
2. Statement of Your Rights
You have a right to know how we may use or disclose your personal health information. This notice informs you of those uses and disclosures. There are certain uses and disclosures of your personal 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:
(a) The right to request that we place additional restrictions on our uses and disclosures of your personal health information (beyond what the law requires), but we are not obligated to agree to any such additional restrictions.
(b) 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.
(c) The right to receive an accounting of the disclosures of your personal health information that we make for purposes other than activities related to your treatment, or our payment functions or other health care operations.
(d) The right to request that you receive communications of personal health information in a confidential manner.
3. Permissible Uses and Disclosures of Protected Health Information:
(a) Payment Functions. We may use or disclose your health information without your permission to carry out activities relating to reimbursing you for the provision of health care, obtaining premiums, determining coverage, and providing benefits under the policy of insurance that you are purchasing. For example, payment functions may include (but are not limited to) reviewing health care services with respect to medical necessity, coverage under the policy, appropriateness of care, or justification of charges.
(b) Health Care Operations. We also may use or disclose your protected health information without your permission to carry out certain insurance-related activities. These activities include using your protected information for underwriting, premium rating, or other activities relating to the creation, renewal or replacement of another contract of health insurance, and ceding, securing, or placing a contract for reinsurance of risk relating to claims for health care.
(c) Uses Permitted/Required By Law. We also may use or disclose your protected health information without your written permission for purposes permitted or required by law.
(d) Authorized Uses. All other uses or disclosures of your protected health information will be made only with your written permission, and any permission that you give us may be revoked by you at any time.
4. Complaints About Misuse of Health Information
You may complain either directly to us or to 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 file a complaint with us in writing. The request should include your name, address, social security number, and telephone number. You must include specific information regarding the violation including the names of the individuals and/or companies involved as well as the date(s) of the event(s). You will not be retaliated against in any way for filing a complaint.
5. Contact Person for Filing Complaint or Obtaining Further Information
Randy Myers, Leland Smith Insurance Services, 1175 Westwood Dr, Ste 200, Van Wert, OH 45891.