20-2113

20-2113. Disclosure limitations and
conditions

An insurance institution, insurance producer or insurance support organization shall
not disclose any personal or privileged information about an individual collected or
received in connection with an insurance transaction unless the disclosure is:

1. With the written authorization of the individual except that:

(a) If the authorization is submitted by another insurance institution, insurance
producer or insurance support organization, the authorization shall meet the requirements
prescribed in section 20-2106.

(b) If the authorization is submitted by a person other than an insurance
institution, insurance producer or insurance support organization, the authorization
shall be dated, signed by the individual and obtained one year or less before the date a
disclosure is sought pursuant to this section.

2. To a person other than an insurance institution, insurance producer or insurance
support organization, if the disclosure is reasonably necessary:

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

(i) Would otherwise be permitted by this section if made by an insurance
institution, insurance producer or insurance support organization.

(ii) Is reasonably necessary for the person to perform the individual's function
for the disclosing insurance institution, insurance producer or insurance support
organization.

(b) To enable the person to provide information to the disclosing insurance
institution, insurance producer or insurance support organization for the purpose of
determining an individual's eligibility for an insurance benefit or payment or detecting
or preventing criminal activity, fraud, material misrepresentation or material
nondisclosure in connection with an insurance transaction.

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

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

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

4. To a medical care institution or medical professional for the purpose of
verifying insurance coverage or benefits, informing an individual of a medical problem of
which the individual may not be aware or conducting an operations or service audit, if
only the information that is reasonably necessary to accomplish the purposes prescribed
by this paragraph is disclosed.

5. To an insurance regulatory authority.

6. To a law enforcement or other governmental authority to protect the interests of
the insurance institution, insurance producer or insurance support organization in
preventing or prosecuting the perpetration of fraud upon it, or if the insurance
institution, insurance producer or insurance support organization reasonably believes
that illegal activities have been conducted by the individual.

7. Otherwise permitted or required by law.

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

9. Made for the purpose of conducting actuarial or research studies, except that no
individual may be identified in any actuarial or research report, materials allowing the
individual to be identified shall be returned or destroyed as soon as they are no longer
needed and the actuarial or research organization shall agree not to disclose the
information unless the disclosure would otherwise be permitted by this section if made by
an insurance institution, insurance producer or insurance support organization.

10. To a party or a 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, insurance producer or insurance support organization, except that before the
consummation of the sale, transfer, merger or consolidation only the information is
disclosed that is reasonably necessary to enable the recipient to make business decisions
about the purchase, transfer, merger or consolidation and the recipient agrees not to
disclose the information unless the disclosure would otherwise be permitted by this
section if made by an insurance institution, insurance producer or insurance support
organization.

11. 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 an individual's character, personal habits, mode of living or general
reputation is disclosed and no classification derived from the information is disclosed.

(b) The individual has been given an opportunity to indicate that the individual
does not want personal information disclosed for marketing purposes and has given no
indication that the individual does not want the information disclosed.

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

12. To an affiliate whose only use of the information will be in connection with an
audit of the insurance institution or insurance producer or the marketing of an insurance
or financial product or service, if the affiliate agrees not to disclose the information
for any other purpose or to an unaffiliated person, except that no medical record
information may be disclosed for marketing purposes without the individual's written
consent.

13. By a consumer reporting agency if the disclosure is to a person other than an
insurance institution or insurance producer.

14. To a group insurance policyholder for the purpose of reporting claims experience
or conducting an audit of the insurance institution's or insurance producer's operations
or services if the information disclosed is reasonably necessary for the recipient to
conduct the review or audit.

15. To a professional peer review organization for the purpose of reviewing the
service or conduct of a medical care institution or medical professional.

16. To a governmental authority for the purpose of determining the individual's
eligibility for health benefits for which the governmental authority may be liable.

17. To a certificate holder or policyholder for the purpose of providing information
regarding the status of an insurance transaction.