Notice of Your Privacy Rights
We know that your trust in us is very important and are committed to protecting your privacy rights. Please read this document carefully. It discloses your privacy rights.
Obtaining Information About You – We may obtain information from your application, a telephone interview with you, claims history with us, policies you have or had with us, account balances and premium payment history, and other sources, such as health care providers (medical information), and consumer reporting agencies. Your address, birthday, telephone number, social security number, prescription drug history, driving record, and credit report are examples of such information. You may have to share such information with us, our affiliates, agencies or others working with us.
Our Use of Personal Information – We will share such information only with companies associated with us. We may use your information to offer you products or help you choose a product.
We may, as permitted by the law and without your prior approval, give information about you to persons who do business for us, including other insurance companies, other persons handling your business, insurance company support organizations, regulatory or law enforcement authorities and our affiliated companies. Information provided to an insurance-support organization may be retained by the insurance-support organization and disclosed to other persons.
Your Rights
- The right to access, inspect and copy the personal information pertaining to you that we maintain in our files about you. We will act on this request within 30 days of the notice date or within 60 days if the requested information is not maintained or accessible to us on-site. Such action will either inform you of the acceptance of the request and provide you with the requested access; or provide a written denial explaining the reasons for the denial and whether you are entitled to have the denial reviewed. If the requested information is contained in more than one designated record set or at more than one location, and access is granted, we need only to provide you with access to information contained on one of the designated record sets.
- The right to request that we correct or amend any personal information that we have about you.
To exercise these rights, please send a written request to the attention of the Privacy Officer.
How We Protect Your Personal Information
We protect the information we share with companies working for us through an agreement. The agreement obligates those companies to keep your information confidential.
Our employees who work to service your business see your personal information. We have trained our employees to closely follow our privacy rules for your protection. Your privacy rights will continue if you cease to be our customer.
The remainder of this notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
We are required to maintain the privacy of your personal medical information and provide you with this notice as to our legal duties and privacy practices. 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 medical information that we maintain about you. If we revise this notice, we will send the revised notice to the address you have supplied us.
Statement of Your Rights
You have the right to know how we use or disclose your personal medical information. There are certain uses and disclosures of your personal medical information that we are permitted or required to make by law without your permission. In addition, you have:
- The right to request that we place additional restrictions on our uses and disclosures of your personal medical information, but we are not obligated to agree to any such restrictions.
- The right to access, inspect and copy the protected information pertaining to you that we maintain in our files, and the right to request that we correct and amend any personal medical information that we have about you.
- The right to receive an accounting of the disclosures of your personal medical 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 communication of personal medical information in a confidential manner.
- The right to obtain a paper copy of this notice from us on request.
To exercise these rights please send a written request to the attention of the Privacy Officer.
Permissible Uses and Disclosures of Protected Medical Information
Payment Functions. We may use or disclose your protected medical 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.
Health Care Operations. We may also use or disclose your protected medical information without your permission to carry out certain insurance-related activities. For example, 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, placing a contract for reinsurance of risk relating to claims for health care, and performing audit functions to ensure compliance and proper claims payment.
Business Associates. We may disclose your protected medical information to our business associates. There are some services provided in our company through contracts with our business associates.
Uses Permitted by Law. We may also use or disclose your protected medical information without your written permission for purposes permitted or required by law.
Authorized Uses. All other disclosures of your protected medical 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 Information
If you believe your privacy rights have been violated you may complain either directly to us or to the Secretary of Health and Human Services. Please submit all complaints in writing to us or the Department of Health and Human Services as follows:
American Community Mutual Insurance Company
Attn: Privacy Officer
39201 Seven Mile Road
Livonia, MI 48152
U.S. Department of Health and Human Services
Attn: Secretary
200 Independence Ave. S.W.
Washington, D.C. 20201
You will not be retaliated against in any way for filing a complaint.
Obtaining Further Information
Please call us at (800) 991-2642 if you have questions or comments.
Effective Date: December 1, 2007
Disclaimer. We may change this Web site privacy statement at any time without prior notice.
