SHAFER INSURANCE AGENCY INC.
Privacy Policies Package
Shafer Insurance Agency is committed to protecting your privacy. In order to fulfill that commitment, we offer the following Privacy Policies:
(Website Visitors & Insurance Customers) Revised 4/24/2015
We will ask you to provide your personally identifiable information (including your email address) when you enroll for coverage, purchase an insurance policy from us, or when you send us an e-mail via your personal email account or from our website. When you enroll for an insurance policy at Shafer Insurance Agency, we will ask you to provide your name, home address, mailing address, telephone number and e-mail address. This information will be provided to the insurance company when you purchase an insurance policy so they can establish you as a policyholder. We will maintain a record of your information at the offices of Shafer Insurance Agency so we can provide you with policyholder service. The employees of Shafer Insurance Agency are each required to sign and acknowledge a Confidentiality and Nondisclosure Agreement. Each employee has been instructed on maintaining the privacy of each customer and the importance of protecting the customer’s personal information.
When you purchase an insurance policy from Shafer Insurance Agency, payments are made via a money order, cashier’s check, or personal check. We will not keep copies of any of these documents.
Our website users will have a cookie stored on their hard drive while visiting the website. A cookie is a piece of data that is stored on a visitor’s computer while they are visiting a website. At Shafer Insurance Agency, a cookie is only used to identify one unique visitor from another visitor during a particular session. A session is the period of active site-use while that unique visitor is linked to our server. We may use cookie technology during a session as a tool to carry forward your input information during the enrollment process. This enables the visitor to input their information once and have the information appear later during the enrollment process. No personally identifiable information is stored on the cookie. The cookie expires and is deleted from the visitor’s computer as soon as they close their browser or if they are not actively browsing our website for more than 20 minutes. Should a previous visitor to our website return for a new session, they will be issued a new cookie and in no way will they be recognized as a visitor from a previous visit or session.
(Financial Information) Revised 4/24/2015
The GLBA further requires that we inform you that you have a right to prevent us from sharing nonpublic personal information about you with a non-affiliated third party for any purpose that is not specifically authorized by law. Your right to prevent us from sharing nonpublic personal information about you with a non-affiliated third party for a purpose that is not specifically authorized by law is called your right to “opt out” of such information sharing.
Information We Collect
We collect nonpublic personal information about you from the following sources:
- Information which we receive from you on applications or other forms (such as your name, address and date of birth);
- Information about your transactions with us, our affiliates (such as payroll or human resource companies) or others; and
- Information which we receive from third parties (such as consumer reporting agencies).
Information We May Disclose To Third Parties:
We may disclose all of the information we collect, as described above, about our customers or former customers to companies that perform marketing, payroll, human resource consulting services on our behalf or to other financial institutions with whom we have joint marketing agreements. We also may disclose information about our customers or former customers as permitted by law.
Non-Affiliated Third Parties to Whom Disclosures May Be Made:
We may disclose nonpublic personal information about you, such as we have described above, to the following types of third parties that perform marketing services on our behalf or with whom we have joint marketing agreements:
- Fulfillment service providers such as billing and enrollment services and collection services.
- Other insurance agencies or companies that perform services for us in connection with carrying out an insurance transaction involving you or your policy
- Financial institutions where we have joint agreements.
- Other types of financial and administrative institutions such as premium finance companies, payroll services, or human resource consulting companies.
We may also disclose nonpublic personal information about you to non-affiliated third parties as permitted by law.
Notification of Your Right to Opt Out of Certain Disclosures:
If you prefer that we do not disclose nonpublic personal information about you to non-affiliated third parties, you may opt out of those disclosures, that is, you may direct us not to make those disclosures (other than those disclosures that are expressly permitted by the Gramm-Leach-Bliley Act and its implementing regulations).
If you wish to exercise your right to opt out of the information sharing described, you must send to the address below a letter in writing indicating that you do not wish for Shafer Insurance Agency, Inc. to share your nonpublic personal information with non-affiliated third parties for purposes other than those that are permitted by law.
Shafer Insurance Agency, Inc.
ATTN: PRIVACY OFFICER
1100 Marion Street, Ste. 200
Knoxville, TN 37921
We restrict access to nonpublic personal information about you to those employees and outside service providers who need to know that information to provide products or services to you. We maintain physical, electronic and procedural safeguards that comply with applicable federal and state regulations to guard your nonpublic personal information.
(Medical Information) Revised 4/24/2015
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
This Notice of Privacy Practices describes how Shafer Insurance Agency and its affiliated companies protect your protected health information (PHI) related to your coverage and how we may use and disclose that information as permitted/required by law.
Uses and Disclosures of Protected Health Information
Your protected health information may be used and disclosed by your physician , our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician’s practice, and any other reuse allowed/required by law.
Protected Health Information means information about an individual that is created or received by our company that either identifies the individual or, based on a reasonable belief, could be used to identify the individual, and that relates to:
- The past, present or future physical or mental health condition of the individual;
- The provision of health care to the individual; or
- The past, present or future payment for the provision of health care to the individual.
Health Plan is defined by HIPAA to include the following individual and group insurance products: major medical, Medicare supplement, hospital indemnity, long term care, dental, specified disease (such as cancer) and pharmacy benefit plans.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we may use or disclose information about your medical procedures and treatments to process and pay claims, to determine whether services are medically necessary or to preauthorize or certify services are covered under your insurance coverage. We may also disclose your Protected Health Information for payment purposes to a health care provider or another “health plan” issued by a different insurance company or HMO.
Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities, which may include but are not limited to, quality assessment activities, business management, accreditation and licensing, peer review, enrollment, reinsurance, compliance, auditing, rating, and other functions relating to servicing your coverage at Shafer.
We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law; Public Health issues as required by law; Communicable Diseases; Health Oversight; Abuse or Neglect; Food and Drug Administration requirements; Legal Proceedings (including Court Orders and Subpoenas); Law Enforcement; Coroners, Funeral Directors, and Organ Donation; Research; Criminal Activity; Military Activity and National Security; Workers’ Compensation. Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.
Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization or opportunity to object unless required by law.
You may revoke this authorization, at any time, in writing by submitting a letter of authorization to our Privacy Officer. However, any action taken by our company or others have already taken in reliance on the authorization cannot be changed.
Following is a statement of your rights with respect to your protected health information.
You have the right to inspect and copy your protected health information.
Under federal law, however, you may not inspect or copy the following records; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or preceding, and protected health information that is subject to law that prohibits access to protected health information. We may charge a reasonable, cost-based fee.
You have the right to request a restriction of your protected health information.
You have the right to choose to restrict any part of your protected health information for the purposes of payment or healthcare operations unless otherwise permitted or required by law. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
You have the right to request to receive confidential communications from us by alternative means or location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively i.e. electronically.
You have the right to request that the Protected Health Information we maintain about you be amended. We are not obligated to make all requested amendments, but will give each request careful consideration. All amendment requests must be in writing, signed by you or your authorized representative, and must state the reasons for the amendment request. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. If the amendment request is part of your medical record, you will need to contact the doctor who wrote the record and request a change. Once the medical record has been changed, have your doctor send a copy to us for our files.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information.
You may complain to us or to the Secretary of Health and Human Service if you believe your privacy rights have been violated by us. You may file a complaint with us by using the following contact information:
Shafer Insurance Agency, Inc.
ATTENTION: Privacy Officer
1100 Marion St., Suite 200
Knoxville, TN 37921
Phone #: 1-865-546-0761
You can file a Complaint with the U.S. Department of Health and Human Services Office of Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, or by calling 1-877- 696-6725, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.
This notice was published and becomes effective on/or before the Effective Date.
We are required by law to maintain the privacy of, and provide individuals with, this notice of your legal duties and privacy practices with respect to protected health information. If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our Main Phone number. If you would like to obtain more information, please visit this website: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Please note that by browsing our website you acknowledge your understanding and acceptance of our Privacy Policies Package.