NAC679B.695. Contents of form to authorize disclosure.

No insurance institution, agent or insurance-support organization may use as its disclosure authorization form for use in connection with an insurance transaction a form or statement which authorizes the disclosure of personal or privileged information about a natural person 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 who may disclose information about the natural person;

     4. Specifies the nature of the information authorized to be disclosed;

     5. Names the insurance institution or agent;

     6. Identifies by generic reference representatives of the insurance institution to whom the natural person is authorizing information to be disclosed;

     7. Specifies the purposes for which the information is collected;

     8. Specifies the length of time the authorization will remain valid, which must be no longer than:

     (a) In the case of authorizations signed to collect information in connection with an application for an insurance policy, the reinstatement of a policy or a request for change in policy benefits:

          (1) Thirty months from the date the authorization is signed if the application or request involves life, health or disability insurance; or

          (2) 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 to collect information in connection with a claim for benefits under an insurance policy:

          (1) The term of coverage of the policy if the claim is for a health insurance benefit; or

          (2) The duration of the claim if the claim is not for a health insurance benefit; and

     9. Advises the natural person or a person authorized to act on behalf of the natural person that he or she is entitled to receive a copy of the authorization form.

     (Added to NAC by Comm’r of Insurance, 10-4-88, eff. 1-1-89)