Lake Forest Insurance Agency, Inc. Privacy Practices
THIS NOTICE DESCRIBES HOW PERSONAL, MEDICAL, AND OTHER PROTECTED INFORMATION ABOUT YOU AND/OR YOUR EMPLOYEES MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Lake Forest Insurance Agency, Inc. (LFI) acts to maintain the privacy of protected health information and provide individuals with notice of LFI’s legal duties and privacy practices with respect to protected health information as described in this Notice and to abide by the terms of the Notice currently in effect.
Provision of Notice: LFI provides its Notice of Privacy Practices to every person with whom it has a direct relationship. The Notice is provided no later than the date of the first contact where protected health information may be exchanged.
LFI makes its Notice available to any member of the public to enable prospective clients to evaluate the LFI’s privacy practices when making his or her decision regarding whether to appoint LFI as his/her insurance broker. LFI provides its Notice via e-mail to any individual who so requests the Notice.
Effective Date and Changes to Notice: This Notice is effective January 01, 2018. LFI reserves the right to revise this Notice whenever there is a material change to the uses or disclosures, the individual’s rights, the covered entitys legal duties, or other privacy practices stated in the Notice. Except when required by law, a material change to any term of the Notice will not be implemented prior to the effective date of the notice in which such material change is reflected.
Contact Person: LFI has a privacy officer that serves as the contact person for all issues related to the Privacy Rule. The privacy officer is Jeff Rivera. If you have any questions about this Notice, please contact Jeff Rivera at (949) 499-9287 or 23052 Alicia Pkwy. # H-423, Mission Viejo, CA 92692.
NOTICE OF PRIVACY POLICY AND INSURANCE INFORMATION PRACTICES
LAKE FOREST INSURANCE AGENCY, INC.
At Lake Forest Insurance Agency, Inc. (LFI), keeping our client information confidential and secure is an important part of our responsibility to you, and we take this responsibility very seriously. In this notification, we describe the policies and practices through which we protect your personal and employee information, and provide you with options about how your information may be shared within LFI and with others as required or permitted by law — including those who may work with us to better serve your needs.
Confidentiality and Security of Your Nonpublic Personal Information
We maintain appropriate physical, electronic and procedural safeguards to maintain the confidentiality and security of your nonpublic personal information. We restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. Our employees are continually trained on how to keep our clients information safe.
Categories of Information That We Collect
We collect nonpublic personal information about you from the following sources:
Information that we receive from you on applications and other forms (including but not limited to: claim forms, enrollment forms, census documents, beneficiary designation forms, assignment of benefits forms, or any other form necessary to administer coverage or assist with administration of our clients’ group and/or individual insurance programs.);
Information about your transactions with us, our affiliates or others;
Information that we receive from you or others to assist in marketing insurance coverage, implementing insurance coverage, and/or administration of coverage as requested by our clients and/or their plan participants;
Information that we receive from you requesting claim assistance for your participants.
Categories of Parties to Whom We May Disclose Information
We may disclose the following kinds of nonpublic personal information about you:
We do not disclose any of the above-described personal information about our current or former clients to any third parties except as permitted by law, such as for completing a requested transaction.
We may provide our client’s personal information to our affiliates or others, including a client’s insurance carrier, third-party administrator, re-insurer, or plan sponsor. These disclosures may be made to others for the purpose of performing administrative services on our client’s behalf. This may include but is not limited to:
Information we receive from you on applications or other forms, such as your name, address, social security number, income, and beneficiary designation; and
Information about your transactions with our affiliates, others, or us such as your policy coverage, premiums, and payment history.
We may disclose all of the information we collect, as described above, about our clients or former clients, to companies that perform services on our behalf or to other institutions with whom we have joint servicing agreements.
Our practices regarding information confidentiality and security:
We restrict access to nonpublic personal information about you to those entities that need the 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.
Changes to Our Notice of Privacy Policy and Insurance Information Practices
We reserve the right to change our privacy policies and insurance information practices. If we make any material changes to our policies or practices, we will provide you with a copy of a revised notice. If there are any questions concerning this privacy notice, please contact us at 1-949-499-9287 or Lake Forest Insurance Agency, Inc., Attention: Privacy Notice, 23052 Alicia Pkwy. # H-423, Mission Viejo, CA 92692.