Washington protected individual - confidentiality request

Washington Insurance Law 284-04-510 requires any company that issues, 提供, 补偿, or renews an individual accident and health insurance policy (including a disability insurance policy) to accommodate a reasonable request by a covered person to receive communications that contain protected health information* by alternative means or at alternative locations regardless of who pays for the plan. If a child under the age of 18 is a covered person, then the right established by the above section may be asserted by the child's parent or guardian.

 

相应的, if you are a resident of the state of Washington, you have the right to have protected health information sent to you instead of the person who pays for your health insurance plan. 在华盛顿州, sensitive health care services** are required to be confidential, but if you have not requested this information to be sent to a different address or by another means, this information will be sent in your name to the address on file. You can ask to be contacted about protected health information and sensitive health services:

  • At a different mailing address
  • 通过电子邮件
  • 通过电话
  • 通过我们的门户

To make this type of request, 完整的, 签字后发给我们, at the mailing address specified 在这里in, the form linked immediately below, or you can call us at: 866-855-1212866-855-1212

Confidentiality Request Form Draft (wa.gov)

The only option available to State Farm® Health Insurance customers is to send to a different address.

请注意:

  • The form linked above can also be used to change or update your confidential contact information.
  • We will 完整的 your request within three business days of receipt.
  • Some laws may require certain communications to be in writing, so please provide an email or mailing address to ensure confidentiality (notwithstanding your preferred communication method).
  • Until your request is processed, we may continue to send your protected health information to the person who is paying for your health insurance.
  • Any call to revoke a request must be made in writing.

*Protected health information means individually identifiable health information State Farm has or sends out in any form. Confidential communication of protected health insurance covered under this request includes:

  • Bills and attempts to collect payment for health care services from your health insurance company (however, this request does not apply to your health care provider).
  • A notice of adverse benefits determination.
  • An explanation of benefits notice.
  • A request for additional information about a claim.
  • A notice of a contested claim.
  • The name and address of a provider, a description of services provided, and other visit information.
  • Any written, oral or electronic communication that contains protected health information.

**Sensitive health care services are health care services related to:

  • Reproductive health care
  • Sexually transmitted diseases
  • Substance-use disorder
  • 性别焦虑症
  • Gender-affirming保健
  • 家庭暴力
  • 心理健康

For questions about requesting confidentiality, please contact us at: 1-866-855-12121-866-855-1212

邮寄地址:

State Farm Mutual Automobile Insurance Company
Attention: Health Operations
邮政信箱2360
布卢明顿，伊利诺伊州61702