NAC679B.730. Limitations upon and conditions of disclosure.

An insurance institution, agent or insurance-support organization shall not disclose personal or privileged information about a natural person collected or received in connection with an insurance transaction unless the disclosure is:

     1. Authorized in writing by the natural person and:

     (a) If the authorization is submitted by a person other than an insurance institution, agent or insurance-support organization, the authorization is:

          (1) Dated;

          (2) Signed by the natural person; and

          (3) Obtained not more than 1 year before the date a disclosure is sought pursuant to this section.

     (b) If the authorization is submitted by another insurance institution, agent or insurance-support organization, the authorization meets the requirements of NAC 679B.695.

     2. Directed to a person other than an insurance institution, agent or insurance-support organization, provided the disclosure is reasonably necessary:

     (a) To enable the person to perform a business, professional or insurance function for the disclosing insurance institution, agent or insurance-support organization and the person agrees not to disclose the information further without the natural person’s written authorization unless the further disclosure:

          (1) Would otherwise be permitted by this section if made by an insurance institution, agent or insurance-support organization; or

          (2) Is reasonably necessary for the person to perform its function for the disclosing insurance institution, agent or insurance-support organization; or

     (b) To enable the person to provide information to the disclosing insurance institution, agent or insurance-support organization in order to:

          (1) Determine a natural person’s eligibility for an insurance benefit or payment; or

          (2) Detect or prevent criminal activity, fraud, material misrepresentation or material nondisclosure in connection with an insurance transaction.

     3. Directed to an insurance institution, agent, insurance-support organization, or self-insurer, if the information disclosed is limited to that which is reasonably necessary:

     (a) To detect or prevent criminal activity, fraud, material misrepresentation or material nondisclosure in connection with insurance transactions; or

     (b) For the disclosing or receiving insurance institution, agent or insurance-support organization to perform its function in connection with an insurance transaction involving the natural person.

     4. Directed to a medical care institution or medical professional to:

     (a) Verify insurance coverage or benefits;

     (b) Inform a natural person of a medical problem of which the natural person may not be aware; or

     (c) Conduct an operations or services audit to verify the natural persons treated by the medical professional or at the medical care institution, provided only information which is reasonably necessary to accomplish the foregoing purposes is disclosed.

     5. Directed to an insurance regulatory authority.

     6. Directed to a law enforcement or other governmental authority:

     (a) To protect the interest of the insurance institution, agent or insurance-support organization in preventing or prosecuting the perpetration of fraud upon it; or

     (b) If the insurance institution, agent or insurance-support organization reasonably believes that illegal activities have been conducted by the natural person.

     7. Otherwise permitted or required by law.

     8. In response to a facially valid administrative or judicial order, including a search warrant or subpoena.

     9. Made to conduct actuarial or research studies, if:

     (a) No natural person may be identified in any actuarial or research report;

     (b) Materials allowing the natural person to be identified are returned or destroyed as soon as they are no longer needed; and

     (c) The actuarial or research organization agrees that the information not be disclosed unless the disclosure would otherwise be permitted by this section if made by an insurance institution, agent or insurance-support organization.

     10. Directed to a party or representative of a party to a proposed or consummated sale, transfer, merger or consolidation of all or part of the business of the insurance institution, agent or insurance-support organization, if:

     (a) Before consummating the sale, transfer, merger or consolidation, only information that is reasonably necessary to enable the recipient to make business decisions about the purchase, transfer, merger or consolidation is disclosed; and

     (b) The recipient agrees not to disclose the information unless the disclosure would otherwise be permitted by this section if made by an insurance institution, agent or insurance-support organization.

     11. Directed to a person whose only use of the information will be in connection with the marketing of a product or service, if:

     (a) No medical record information, privileged information, or personal information relating to a natural person’s character, personal habits, mode of living or general reputation is disclosed, and no classification derived from the information is disclosed;

     (b) The natural person has been given an opportunity to indicate that he or she does not want personal information disclosed for marketing purposes and has given no indication that he or she does not want the information disclosed; and

     (c) The person receiving the information agrees not to use it except in connection with the marketing of a product or service.

     12. Directed to an affiliate whose only use of the information will be in connection with an audit of the insurance institution or agent or the marketing of an insurance product or service, if the affiliate agrees not to disclose the information for any other purpose or to unaffiliated persons.

     13. Made by a consumer reporting agency, if the disclosure is to a person other than an insurance institution or agent.

     14. Directed to a group policyholder to report claims experience or conduct an audit of the insurance institution’s or agent’s operations or services, if the information disclosed is reasonably necessary for the group policyholder to conduct the review or audit.

     15. Directed to a professional peer review organization to review the service or conduct of a medical care institution or medical professional.

     16. Directed to a governmental authority to determine the natural person’s eligibility for health benefits for which the governmental authority may be liable.

     17. Directed to a certificate holder or policyholder to provide information regarding the status of an insurance transaction.

     18. Directed to a lienholder, mortgagee, assignee, lessor or other person shown on the records of an insurance institution or agent as having a legal or beneficial interest in a policy of insurance, if:

     (a) No medical record information is disclosed unless the disclosure would otherwise be permitted by this section; and

     (b) The information disclosed is limited to that which is reasonably necessary to permit the person to protect his or her interests in the policy.

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