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SECURIAN LIFE INSURANCE COMPANY
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.
Securian Life Insurance Company understands that information about you and your health is personal, and we are committed to protecting your dental information. Individually identifiable information about your past, present or future health or condition, the provision of dental care to you, or payment for such dental care is considered "Protected Health Information" ("PHI").
Our Permitted Uses and Disclosures of Your Protected Health Information
Treatment: We may disclose PHI to your dentist(s) for treatment purposes. For example, your dentist may wish to provide a dental service to you but first seek information as to whether the service has been previously provided.
Payment: We disclose your PHI in order to fulfill our duty to provide your coverage, determine your benefits and make payment for services provided to you. For example, we use your PHI in order to process your claims.
Health Care Operations: We disclose your PHI as a part of certain operations, such as quality improvement. For example, we may use your PHI to evaluate the quality of dental services that were performed.
We may be asked by the sponsor of your dental plan to provide your PHI to the sponsor. If we are asked to do so, we intend to honor such requests unless we are prohibited by law from doing so.
We may use or disclose your PHI without your authorization for several other reasons. Subject to certain requirements, we may give out PHI without your authorization for public health purposes, auditing purposes, research studies and emergencies. We provide PHI when otherwise required by law, such as for law enforcement in specific circumstances, or for judicial or administrative proceedings. In any other situation, we will ask for your written authorization before using or disclosing your PHI. If you choose to sign an authorization to allow disclosure of your PHI, it is valid for no more than twenty-four months. You can revoke your authorization at any time to stop any future uses and disclosures (other than for treatment, payment and health care operations). To obtain an authorization or revocation form, please call Customer Service at (800) 234-9009.
We may change our policies at any time. Before we make a significant change in our policies, we will change our notice and send the new notice to you. We reserve the right to make the revised or changed notice effective for dental information we already have about you as well as any information we receive in the future. You can also request a paper copy of our notice at any time by contacting the address below, or view it on our website at http://www.securiandental.com.
You may request in writing that we not use or disclose your PHI for treatment, payment and health care operations except when specifically authorized by you, when required by law, or in emergency circumstances. Although we are unable to take back any disclosures we have already made with your permission or pursuant to this notice, we will consider your request but are not legally required to accept it. You also have the right to receive confidential communications of PHI by alternative means or at alternative locations, if you clearly state that disclosure of all or part of your PHI could endanger you.
Our Legal Duty
If you wish to inspect your records, receive a listing of disclosures, or correct or add to the information in your record, or if you have any questions, complaints or concerns, please contact:
Privacy Contact Person