P.O. Box 494010
Redding, CA 96049-4010
As of April 1, 2011
PURPOSE OF THIS NOTICE
Title V of the Gramm-Leach-Bliley Act (GLBA) and the laws of the State of California 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 the laws of this State, we are providing you with this document, which notifies you of the privacy policies and practices of Northern California Insurance Services.
OUR PRIVACY POLICIES AND PRACTICES
We collect nonpublic personal information about you from the following sources:
- Information we receive from you on applications or other forms
- Information about your transactions with us or the insurance companies we represent
- Information we receive from consumer reporting agencies, including motor vehicle records, credit reports or claims history
- Information we receive from medical records or medical professionals
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 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 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, 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 interest in preventing or prosecuting fraud, or if we believe that you have conducted illegal activities
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 Kelly Bickett, Northern California Insurance Services, PO Box 494010, Redding, CA 96049-4010. 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 Kelly Bickett, Northern California Insurance Services, PO Box 494010, Redding, CA 96049-4010. 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.
Our policy 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.
Our policy regarding dispute resolution:
Reservation of the right to disclose information in unforeseen circumstances:
In connection with the potential sale or transfer of its interests, Northern California Insurance Services reserves the right to sell or transfer your information (including but not limited to your name, address, 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 Northern California Insurance Services; 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.
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 by regular mail with a 30-day advance notice.
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:
- 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.
- 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.
- 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.
- The right to request that you receive communications of personal health information in a confidential manner.
Permissible Uses and Disclosures of Protected Health Information
- 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 health care services with respect to medical necessity, coverage under the policy, appropriateness of care, or justification of charges.
- 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.
- 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.
- 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.
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 submit a complaint in writing that includes as many details (such as names and dates) as possible. You will not be retaliated against in any way for filing a complaint.
Contact Person for Filing Complaint or Obtaining Further Information
Northern California Insurance Services
PO Box 494010
Redding, CA 96049-4010