Ohio Revised Code
Chapter 3904 | Insurance Information Practices
Section 3904.06 | Disclosure Authorization Form.

Effective: June 29, 1995
Latest Legislation: House Bill 329 - 120th General Assembly
No insurance institution, agent, or insurance support organization shall use as its disclosure authorization form in connection with insurance transactions a form or statement that 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:
(A) Is written in plain language;
(B) Is dated;
(C) Specifies the types of persons authorized to disclose information about the individual;
(D) Specifies the nature of the information authorized to be disclosed;
(E) 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;
(F) Specifies the purposes for which the information is collected;
(G) Specifies the length of time such authorization shall remain valid, which shall be no longer than:
(1) 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, thirty months from the date the authorization is signed;
(2) In the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy:
(a) The term of coverage of the policy if the claim is for a health insurance benefit;
(b) The duration of the claim if the claim is not for a health insurance benefit.
(H) Advises the individual or a 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.

Structure Ohio Revised Code

Ohio Revised Code

Title 39 | Insurance

Chapter 3904 | Insurance Information Practices

Section 3904.01 | Insurance Information Practices Definitions.

Section 3904.02 | Applicability of Chapter.

Section 3904.03 | Pretext Interviews.

Section 3904.04 | Institution or Agent to Provide Notice of Information Practices to Applicants and Policyholders.

Section 3904.05 | Marketing or Research Questions.

Section 3904.06 | Disclosure Authorization Form.

Section 3904.07 | Investigative Consumer Report.

Section 3904.08 | Written Request for Access to Recorded Personal Information.

Section 3904.09 | Correction, Amendment or Deletion of Information.

Section 3904.10 | Written Reason for Adverse Underwriting Decision Summary of Rights.

Section 3904.11 | Inquiry Concerning Previous Adverse Underwriting Decision.

Section 3904.12 | Prohibited Bases for Adverse Underwriting Decision.

Section 3904.13 | Disclosure of Personal or Privileged Information.

Section 3904.14 | Obtaining Information Under False Pretenses.

Section 3904.15 | Superintendent May Examine and Investigate Conduct.

Section 3904.16 | Superintendent to Issue and Serve Statement of Charges and Notice of Hearing.

Section 3904.17 | Organization Transacting Business Outside State - Superintendent of Insurance to Accept Service of Process.

Section 3904.18 | Cease and Desist Order or Report Finding No Violation - Petition for Review.

Section 3904.19 | Penalties for Knowing Violation or Violation of Cease and Desist Order.

Section 3904.20 | Review of Order or Report of Superintendent by Court of Common Pleas.

Section 3904.21 | Action by Person Whose Rights Are Violated.

Section 3904.22 | Authorized Disclosures of Personal or Privileged Information - Immunity.