Notwithstanding any other provision of law of this state, no insurance institution, agent, or insurance-support organization may utilize as its disclosure authorization form in connection with insurance transactions a form or statement which authorizes the disclosure of personal or privileged information about an individual to the insurance institution, agent, or insurance-support organization unless the form or statement: (1) Is written in plain language; (2) Is dated; (3) Specifies the types of persons authorized to disclose information about the individual; (4) Specifies the nature of the information authorized to be disclosed; (5) Names the insurance institution or agent and identifies by generic reference representatives of the insurance institution to whom the individual is authorizing information to be disclosed; (6) Specifies the purposes for which the information is collected; (7) Specifies the length of time such authorization shall remain valid, which shall be no longer than: (A) In the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement or a request for change in policy benefits: (i) Thirty months from the date the authorization is signed if the application or request involves life, health, or disability insurance; (ii) One year from the date the authorization is signed if the application or request involves property or casualty insurance; or (B) In the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy: (i) The term of coverage of the policy if the claim is for a health insurance benefit; (ii) The duration of the claim if the claim is not for a health insurance benefit; and (8) Advises the individual or person authorized to act on behalf of the individual that the individual or the individual's authorized representative is entitled to receive a copy of the authorization form. Notwithstanding any other provision of law of this state, no insurance institution, agent, or insurance-support organization may utilize as its disclosure authorization form in connection with insurance transactions a form or statement which authorizes the disclosure of personal or privileged information about an individual to the insurance institution, agent, or insurance-support organization unless the form or statement: (1) Is written in plain language; (2) Is dated; (3) Specifies the types of persons authorized to disclose information about the individual; (4) Specifies the nature of the information authorized to be disclosed; (5) Names the insurance institution or agent and identifies by generic reference representatives of the insurance institution to whom the individual is authorizing information to be disclosed; (6) Specifies the purposes for which the information is collected; (7) Specifies the length of time such authorization shall remain valid, which shall be no longer than: (A) In the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement or a request for change in policy benefits: (i) Thirty months from the date the authorization is signed if the application or request involves life, health, or disability insurance; (ii) One year from the date the authorization is signed if the application or request involves property or casualty insurance; or (B) In the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy: (i) The term of coverage of the policy if the claim is for a health insurance benefit; (ii) The duration of the claim if the claim is not for a health insurance benefit; and (8) Advises the individual or person authorized to act on behalf of the individual that the individual or the individual's authorized representative is entitled to receive a copy of the authorization form. Notwithstanding any other provision of law of this state, no insurance institution, agent, or insurance-support organization may utilize as its disclosure authorization form in connection with insurance transactions a form or statement which authorizes the disclosure of personal or privileged information about an individual to the insurance institution, agent, or insurance-support organization unless the form or statement: (1) Is written in plain language; (2) Is dated; (3) Specifies the types of persons authorized to disclose information about the individual; (4) Specifies the nature of the information authorized to be disclosed; (5) Names the insurance institution or agent and identifies by generic reference representatives of the insurance institution to whom the individual is authorizing information to be disclosed; (6) Specifies the purposes for which the information is collected; (7) Specifies the length of time such authorization shall remain valid, which shall be no longer than: (A) In the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement or a request for change in policy benefits: (i) Thirty months from the date the authorization is signed if the application or request involves life, health, or disability insurance; (ii) One year from the date the authorization is signed if the application or request involves property or casualty insurance; or (B) In the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy: (i) The term of coverage of the policy if the claim is for a health insurance benefit; (ii) The duration of the claim if the claim is not for a health insurance benefit; and (8) Advises the individual or person authorized to act on behalf of the individual that the individual or the individual's authorized representative is entitled to receive a copy of the authorization form. Notwithstanding any other provision of law of this state, no insurance institution, agent, or insurance-support organization may utilize as its disclosure authorization form in connection with insurance transactions a form or statement which authorizes the disclosure of personal or privileged information about an individual to the insurance institution, agent, or insurance-support organization unless the form or statement: (1) Is written in plain language; (2) Is dated; (3) Specifies the types of persons authorized to disclose information about the individual; (4) Specifies the nature of the information authorized to be disclosed; (5) Names the insurance institution or agent and identifies by generic reference representatives of the insurance institution to whom the individual is authorizing information to be disclosed; (6) Specifies the purposes for which the information is collected; (7) Specifies the length of time such authorization shall remain valid, which shall be no longer than: (A) In the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement or a request for change in policy benefits: (i) Thirty months from the date the authorization is signed if the application or request involves life, health, or disability insurance; (ii) One year from the date the authorization is signed if the application or request involves property or casualty insurance; or (B) In the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy: (i) The term of coverage of the policy if the claim is for a health insurance benefit; (ii) The duration of the claim if the claim is not for a health insurance benefit; and (A) In the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement or a request for change in policy benefits: (i) Thirty months from the date the authorization is signed if the application or request involves life, health, or disability insurance; (ii) One year from the date the authorization is signed if the application or request involves property or casualty insurance; or (i) Thirty months from the date the authorization is signed if the application or request involves life, health, or disability insurance; (ii) One year from the date the authorization is signed if the application or request involves property or casualty insurance; or (B) In the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy: (i) The term of coverage of the policy if the claim is for a health insurance benefit; (ii) The duration of the claim if the claim is not for a health insurance benefit; and (i) The term of coverage of the policy if the claim is for a health insurance benefit; (ii) The duration of the claim if the claim is not for a health insurance benefit; and (8) Advises the individual or person authorized to act on behalf of the individual that the individual or the individual's authorized representative is entitled to receive a copy of the authorization form.
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