California Confidentiality Request

California law requires any company that issues, 提供, amends or renews health insurance policies to accommodate a reasonable request by a covered person to receive communications that contain medical information* by alternative means or at alternative locations regardless of who pays for the plan. 

相应的, if you are a resident of the state of California, you have the right to have protected health information sent to you instead of the person who pays for your health insurance plan. 在加州, 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

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, 或者您可以致电: 866-855-1212866-855-1212.

California Confidentiality Request Form

注意:

• The form linked above can also be used to change or update your confidential contact information.
• Request received via first class mail will be processed within 14 calendar days of receipt.
• Request received by telephone will be processed within 7 calendar days of receipt.
• Some laws may require certain communications to be in writing, so please provide an 电子邮件 or mailing address to ensure confidentiality (notwithstanding your preferred communication method).
• Until your request is processed, we may continue to send your medical information to the person who is paying for your health insurance.
• Any request to revoke a confidentially request must be made in writing.

*Medical information means individually identifiable health information State Farm has or sends out in any form. Medical information includes information regarding a patient’s medical history, 精神或身体状况, 或治疗.  Individually identifiable means the medical information includes or contains elements such as name, 电子邮件, 物理地址, 电话号码, 或者社会安全号码, 或者其他信息, alone or in combination with other publicly available information, reveals the individual’s identity. Confidential communication of medical information 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:

• 生殖保健
• Sexually transmitted diseases
• 物质使用障碍
• 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: 866-855-1212866-855-1212.

邮寄地址:

State Farm Mutual 汽车mobile pp王者电子官网 Company
Attention: 健康 Operations
邮政信箱2360
布卢明顿，伊利诺伊州61702