HIPAA Privacy Statement

COUNTRY Financial®

Notice of Privacy Practices for the Use and Disclosure of Protected Health Information ("Notice")

Effective Date: November 1, 2016

This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this Notice carefully.

We care about the privacy of your protected health information. We are required by law to maintain the privacy of that information and to provide you with this Notice of our legal duties and privacy practices that are currently in effect. Furthermore, we are required by law to notify you following a breach of unsecured protected health information. Except as outlined below, we will not use or disclose your protected health information for any purpose without your written authorization.

We reserve the right to change our privacy practices, procedures, and terms of this HIPAA Privacy Statement and to make new provisions effective for all protected health information we maintain, as allowed by law. Should our information practices change, we will post the revised Notice on our website at countryfinancial.com and notify you about the revised Notice at the next mailing we send to you at the address you have given us. If you have any questions about this Notice, please contact us. Contact information is provided in the “How to Contact Us” section at the end of this Notice.

What Information is protected?

Your protected health information is a combination of both your medical information and individually identifiable information. Medical information is your personal or health information that was created or received by a healthcare provider or health plan and relates to:

• physical or mental health conditions
• the provision of health care to you, or
• payments for the provision of health care to you.

Some examples of individually identifiable information are your name, address, birth date, and Social Security Number. In the remainder of this Notice, “information” and “health information” mean both medical information and individually identifiable information. We take steps reasonably designed to protect your information whether it is in electronic, written, or oral form.

If you reside in a state whose law provides privacy protections more stringent than those provided by HIPAA, we will maintain the privacy of your information as required by your stricter state law.

Uses and disclosures of your information with your written authorization

Except as otherwise permitted or required by law, COUNTRY Life Insurance Company® itself or through its service affiliate, CC Services, Inc. (collectively referred to here as “COUNTRY”) will request your written authorization before using or disclosing your information. For instance, we will request your written authorization prior to using or disclosing your information for marketing by third parties, or using or disclosing your information in a way that constitutes a sale of your information. In addition, other uses and disclosures not described in this Notice will also be made only with your written authorization.

You may revoke your authorizations at any time by writing to us. However, please be aware that your revocation will not apply to any action COUNTRY has taken in reliance of your initial authorization.

Uses and disclosures of your information without your written authorization

We may use and disclose your information without your written authorization for payment, healthcare operations, or treatment. We have listed below some examples of uses and disclosures that fall under these categories, although not every use and disclosure is listed here.

• For payment
  

  We may use and disclose your information as necessary for payment purposes. For example, we may use information regarding your medical procedures and treatment to process and pay claims.

• For health care operations
  

  We may use and disclose your information as necessary, and as permitted by law, for our health care operations. Health care operations can include a variety of our usual business activities. For example, we may disclose your information to underwrite your policies (although we are prohibited from using or disclosing genetic information for such a purpose). Other examples of health care operations may include helping to evaluate your request for insurance or benefits, performing general administrative activities, and assisting in processing transactions requested by you or for your benefit.

  Your information may also be used and disclosed for us to perform client service activities, manage claims, conduct peer review and research projects, prevent and detect fraud and abuse, and for other important functions related to your health plan.  

  We may also contact you without your written authorization to provide information about other health-related benefits, or products and services that may be of interest to you -- especially when we offer a health insurance product that could enhance or substitute your existing coverage.

• For treatment

  With your approval, we may disclose limited information to a designated family member, relative, your personal representative, or any other person you may identify, provided the information is directly relevant to their involvement with caring for you or payment for your care.

  In certain circumstances, we may share limited information with a designated family member, relative, your personal representative, or any other person you may identify without your written authorization if you are unavailable, incapacitated, or facing an emergency medical situation. The information we share in these circumstances is limited to information that is directly relevant to that person’s involvement with caring for you or in paying for your care.

  If you have designated a person to receive information regarding payment of the premium on your long-term care or Medicare supplement policy, we will inform that person when your premium has not been paid.

• To our business associates

  From time to time, we may, without your written authorization, provide your information to one or more outside persons and organizations who assist us with our business activities. Examples of these outside people and organizations include our duly appointed insurance representatives, financial auditors, quality accreditation services, reinsurers, legal services, enrollment and billing services, or claim payment and medical management services.

  If you have a group health plan through COUNTRY, we may also disclose protected health information to the sponsor of the plan, if any.

Additional uses and disclosures

We are permitted or required by law to make certain other uses and disclosures of your personal health information without your authorization. Examples include:

• to a government oversight agency conducting audits, investigations, or civil or criminal proceedings, as required by law;
• in response to a court or administrative ordered subpoena, discovery request, or in response to a qualified protective order;
• as required by law, if we suspect child abuse or neglect or if we believe you to be a victim of abuse, neglect, or domestic violence;
• as required by law to report wounds, injuries, or crimes to law enforcement officials;
• as required by law to coroners and/or funeral directors;
• if it is necessary to arrange an organ or tissue donation from you or a transplant for you;
• required reporting of disease, injury, birth and death, and for public health investigations;
• to workers’ compensation agencies if necessary for your workers’ compensation benefit determination;
• for national security or intelligence activity or, if you are a member of the military, as required by the armed forces; and
• to public health agencies if we believe there is a serious health or safety threat.  

Your information rights  

Your health record is the physical property of the health care practitioner of the facility that compiled it but the information in it belongs to you. The following are your rights with respect to your information:

• The right to request access to your information

  You have the right to review and obtain a copy of most of your information. We may deny your request to access certain information, as permitted or required by law. We may ask you to request such access in writing and to provide us with as much detailed information as you can regarding the information you wish to review. If you request copies, we may charge you a reasonable fee based on the cost of copying and postage.

• The right to request an amendment of your information

  You have the right to request an amendment of information we maintain about you if you believe the information is wrong or incomplete. We are not legally obligated to make all requested amendments. If we deny your request, we will give you a written explanation.

• The right to request an accounting of your information

  You have the right to request an accounting, or list, of instances in which we or our business associates have disclosed your information for purposes other than treatment, payment, health plan operations, and certain other activities including disclosures made in accordance with an authorization from you. Requests must be made in writing. Unless you specify a shorter time frame, your accounting will include disclosures of your information made within the six years prior to the date of your request.

  There will be no charge for the first list we provide to you. For any additional lists that you request in any 12-month period, you will be charged a reasonable, cost-based fee for responding to these additional requests.

• The right to request restrictions on the use and disclosure of your information

  You have the right to request restrictions on some of our uses or disclosures of your information if the disclosures are for the purpose of medical treatment, payment, or health care operations. Requests must be made in writing. We are otherwise not required to agree to a requested restriction unless the applicable disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law or the information pertains solely to a health care item or service for which you, or someone on your behalf, has paid us in full. If we do agree to a restriction, we may not use or disclose your protected health information in violation of that restriction, unless it is needed for an emergency.

• The right to request confidential communications

  You have the right to request confidential communications from us regarding your information by alternative means or at another address. For example, you may ask that messages not be left on voice mail or that correspondence not be sent to a particular address. Requests must be made in writing. We are required to accommodate reasonable requests if you inform us that disclosure of all or part of your information could endanger your health or safety.

How to contact us or obtain a copy of this Notice

If you have questions or need further assistance regarding this Notice, you may contact COUNTRY at 866-COUNTRY (866-268-6879), or by mail at:

Client Relations
COUNTRY Financial
P.O. Box 2020
Bloomington, Illinois 61702-2020.

If you wish to exercise any of the above mentioned rights, you may contact COUNTRY by mail at the address listed above.

You may obtain a paper copy of this Notice at any time. Please contact us and we will mail it to you. Additionally, you can access our Website at countryfinancial.com and go to the Security and Privacy link. There, you will see a link to our HIPAA Privacy Statement.

Complaints

If you believe your health privacy rights have been violated, you can file a complaint with us, in writing, at the above address. You may also file a complaint with the United States Secretary of Health and Human Services. There will be no retaliation for filing a complaint.