HIPAA Privacy Notice


This Notice applies to Health Plans issued by Southwest Service Life Insurance Company. And, the Notice applies to the personal health information (PHI) that comes under our control on or after April 14, 2003.

We are required by law to:
- maintain the privacy of PHI,
- provide you with notice of our legal duties and privacy practices regarding your PHI, and
- abide by the terms of this Notice so long as it remains in effect.

We reserve the right to change the terms of this Notice as necessary and to make the new Notice effective for all PHI maintained by us. Copies of revised notices will be mailed to all active policyholders. A copy of the current Notice can be obtained at the address shown below. In the event your state provides privacy protections that are more stringent than those provided by HIPAA, we will maintain your PHI in accordance with the more stringent state standard.

Health Plan means, for purposes of this Notice, the following coverages issued by us: Medicare supplement, specified disease (e.g., cancer), hospital indemnity, limited benefit medical-surgical, and other coverages that meet the definition of Health Plan contained in HIPAA. The following products are not considered Health Plans: accident only and life insurance.
HIPAA means the federal Health Insurance Portability and Accountability Act of 1996 and the Privacy Regulation written by the Health and Human Services Department as a result of HIPAA.
Protected Health Information (“PHI”) means individually identifiable health information, as defined by HIPAA, that is created or received by us and that relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual, and that identifies the individual or for which there is a reasonable basis to believe the information can be used to identify the individual. PHI includes information of persons living or deceased.

Your Authorization. Except as outlined below, we will not use or disclose your PHI for any purpose unless you have signed an authorization for the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action under the authorization.
Use and Disclosure for Payment. We may use and disclose your PHI as necessary for payment purposes. For example, we may use information regarding your medical procedures and treatment to process and pay claims, to determine whether services are medically necessary or to otherwise preauthorized or certify services as covered under your Health Plan. We may also forward such information to another health plan which may also have an obligation to process and pay claims on your behalf.
Use and Disclosure for Health Care Operations. We may use and disclose your PHI as necessary, and as permitted by law, for our health care operations. Examples include, business management, utilization review and management, quality improvement and assurance, enrollment, underwriting, reinsurance, compliance, auditing, rating, and other functions related to your coverage. We may also disclose your PHI to another health care facility, health care professional, or health plan for such things as quality assurance and case management, but only if that facility, professional, or plan also has or had a relationship with you.
Family and Friends Involved In Your Care. With your prior approval, we may disclose your PHI to designated family, friends, and others to facilitate their involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation, and we determine that a limited disclosure may be in your best interest, we may share limited PHI with such individuals without your approval. If you have designated a person to receive information regarding payment of the premium on your Health Plan, we will inform that person when your premium has not been paid. We may also disclose limited PHI to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
Business Associates. Some of our services may be performed through contracts with outside persons or organizations, such as auditing, actuarial services, legal services, etc. At times it may be necessary for us to provide some of your PHI to one or more of these outside persons or organizations. In all cases, we require these business associates to safeguard the privacy of your PHI.
Other Products or Services. We may, from time to time, use your PHI to determine whether you might be interested in or benefit from treatment alternatives or other programs, products or services which may be available to you.
Information Received Pre-enrollment. We may request and receive from you and your health care providers PHI prior to the issuance of coverage. We will use this information to determine whether you are eligible for coverage, and to determine your rates. We will protect the confidentiality of that information in the same manner as all other PHI we maintain and, if coverage is not issued, we will not use or disclose your PHI for any other purpose except as permitted or required by law.

Other Uses and Disclosures. We are permitted or required by law to use and disclose your PHI, in certain cases, without your authorization. We may disclose your PHI for any purpose required by law. And, for example:
- We may disclose your PHI for public health activities, such as required reporting of disease, injury, birth and death, and for required public health investigations;
- We may disclose your PHI as required by law if we suspect child abuse or neglect; we may also release your PHI as required by law if we believe you to be a victim of abuse, neglect, or domestic violence;
- We may release your PHI to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
- We may disclose your PHI if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
- We may disclose your PHI if required to do so by a court or administrative order subpoena or discovery request; in most cases you will have notice of such release;
- We may disclose your PHI to law enforcement officials as required by law to report wounds, injuries and crimes;
- We may disclose your PHI to coroners and/or funeral directors consistent with law;
- We may disclose your PHI, if necessary, to arrange an organ or tissue donation from you or a transplant for you;
- We may disclose your PHI for certain research purposes, but only as permitted by law;
- We may disclose your PHI if you are a member of the military as required by armed force services;
- We may disclose your PHI if necessary for national security or intelligence activities; and
- We may disclose your PHI to workers' compensation agencies, if necessary, for your workers' compensation benefit determination.

Access to Your PHI. You have the right to a copy and/or to inspect much of the PHI that we retain. All requests for access must be made in writing and signed by you or your representative. We may charge you a fee for copying and postage and for preparing a summary of the requested information if you request a summary. Access request forms are available at our address shown below.
Amendments to Your PHI. You have the right to request that your PHI be amended by the individual who created the PHI as they would be responsible for responding to your amendment request. Amendment requests must be in writing, signed by you or your representative, and must state the reasons for the amendment request.
Accounting for Disclosures of Your PHI. You have the right to receive an accounting of certain disclosures of PHI made by us after April 14, 2003. Requests must be in writing and be signed by you or your representative. The first accounting in any 12-month period is free. You may be charged a fee for each subsequent accounting we make within the same 12-month period. Accounting request forms are available at our address shown below.
Restrictions on Use and Disclosure of Your PHI. You have the right to request restrictions on certain of our uses and disclosures of your PHI for treatment, payment, or health care operations by requesting a restriction in writing. We are not required to agree to your restriction. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction by sending such termination notice to our address shown below. Restriction request forms are available at our address shown below.
Communications With You. We may communicate with you regarding your claims, premiums, or other aspects of your coverage. You have the right to request, and we will accommodate reasonable requests by you, to receive communications regarding your PHI by alternative means or at alternative locations. For example, if you do not want messages left on your voice mail or you want messages sent to a particular address, we will accommodate reasonable requests. You may request such confidential communication in writing and may send your request to our address shown below. In order to be considered "reasonable" the request must include an explanation as to why normal means of communications would endanger you.
Complaints. If you believe your privacy rights have been violated, you can file a complaint in writing with us at the address shown below, Attn: Privacy Officer. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington, D.C. in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.


If you have questions regarding this Notice, or want to request any of the forms mentioned in the Notice, you may contact us by writing to: Southwest Service Life Insurance Company, Attention: Customer Service, P.O. Box 982005, Fort Worth, Texas 76182-8005; or by calling (817) 284-4888 and asking for Customer Service.


This Notice is effective April 14, 2003.

Form §164.520 (4-2003)