HIPPA INFORMATION AND CONSENT

The Health Insurance Portability and Accountability Act (HIPPA) provide safeguards to protect your privacy. Implementation of HIPPA
requirements officially began on April 14, 2003. Many of the policies have been our practice for years. This is a “friendly” version. What this is all about, specifically, there are rules and restrictions on who may see or be notified of your protected health Information (PHI) as well as your protected Identifiable Information (PII). These restrictions do not include the normal interchange of information necessary to provide you with services. HIPPA provides certain rights and protection to you as the
client. We balance these needs with our goal of providing you with quality professional services. Additional information is available from the US Department of Health and Human Services

WE HAVE ADOPTED THE FOLLOWING POLICIES

1. Client information will be kept confidential except as is necessary to provide services to ensure that all administrative matters related to your insurance services are handled appropriately. Specifically this includes the assembling and transmitting of information with insurance companies with which we do business. Client files are stored in locked filing cabinets and on secured servers through our HIPPA compliant hosted services through agency management systems known as Agency Bloc. During the normal course of providing services these records may be left at least temporarily open in administrative areas. Records will not be available to those other than office staff. You agree to the normal procedures utilize within the office for handling of client records.

2. It is the policy of the agency to contact you from time to time for purposes of updating information, processing renewals or new product offerings. We may do this by telephone, email, us mail or by any means convenient for our agency unless you request a different means. We may send you other communications informing you of changes in office policies or insurance offerings.

3. Our agency uses a number of vendors in the conduct of business. These vendors may have access to PHI and PII, but must agree to abide by confidentiality rules of HIPPA.

4. You understand and agree to inspection by government agencies or insurance providers which may include PHI and PII in the normal performance of their duties.

5. You agree to bring any concerns or complaints regarding privacy to the attention of the agency manager.

6. Your confidential PHI and will not be used for purposes of marketing or advertising of products, good or services nor will it be sold, transferred or released or a third party vendor for such purposes.

7. We agree to provide clients with access to their records in accordance with state and federal laws.

8. We may change, add, delete modify any of these provision to better serve the needs of the both the Agency and its clients.

By engaging the services of Brevard Health Exchange, the client, does hereby consent and acknowledge their agreement to the terms set forth in the HIPPA information Form and subsequent changes if office policy. You further understand that this consent shall remain in force from this time forward unless you notify in writing by US mail to our main office