Home

The below is sample text….

The Company is permitted to use and disclose protected health information to underwrite health risks and to administer and pay claims on health risks it insures.

Otherwise, the Company will not use or disclose protected health information except:

•  To the individual to which the protected health information pertains upon the written request of that individual.
•  Pursuant to and in compliance with a valid authorization signed by the individual to which the protected health information pertains;
provided that the individual may revoke such authorization in writing.
•  To the Company’s affiliate, Citizens Financial Corporation, pursuant to an agreement requiring Citizens Financial Corporation to
abide by the terms of this Notice.
•  To create and disclose health information that is not identifiable with any individual.
•  When required by the Secretary of Health and Human Services.
•  When required in judicial or administrative proceedings or for law enforcement purposes.
•  When necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

RIGHTS OF INDIVIDUALS

An individual has the following rights with respect to protected health information pertaining to that individual:

•  To request the Company to place additional restrictions on the use and disclosure of protected health information; provided that the
Company is not legally required to agree to such additional restrictions.
•  To require the Company to send confidential communications of protected health information to him or her by alternative means or
at an alternative location if the individual states that the disclosure of all or part of the protected health information could endanger
the individual.
•  To require the Company to permit the individual to inspect and copy protected health information.
•  To require the Company to mend inaccurate or incomplete protected health information created by the Company.
•  To require the Company to account to the individual for disclosures of protected health information; provided, the
Company is not required to account for disclosures required for treatment, payment or health care operation, or which are permitted
by this Notice.
•  To require the Company to provide a paper copy of this Notice to the individual.

The above rights may be exercised by the individual delivering a written notice to the Company specifying the right or rights which the individual is exercising.

COMPLAINTS

Individuals may file a written complaint with the Company and the Secretary of Health and Human Services if they believe their privacy rights have been violated. Individuals will not be retaliated against for filing a complaint.

RIGHTS OF INDIVIDUALS

The Company reserves the right to amend this Notice provided the amended Notice complies with all applicable laws and is delivered to the individuals to which the amended Notice applies.

Individuals requiring further information concerning the Company’s privacy policies and this Notice should contact:

ATTN: Policyowners Service Department
Citizens Security Life Insurance Company
12910 Shelbyville Road, Suite 300
Louisville, Kentucky 40243

Phone:  800.843.7752  (502.244.2420)
Fax:  502.244.2439

EFFECTIVE DATE
This Notice is effective April 14, 2003.