HIPAA Privacy Statement

COUNTRY^® Financial

Notice of Privacy Practices for the Use and Disclosure of Protected Health Information

Effective Date: January 1, 2011

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We care about the privacy of your protected health information. We are required by law to maintain the privacy of that information and to provide you with this notice of our legal duties and privacy practices. Unless you give us a written authorization, we will only disclose your protected health information for treatment, payment or health care operations or when we are otherwise required or permitted by law to do so.

Examples of Usage and Disclosures for Treatment, Payment and Health Care Operations

We may use and disclose your protected health information for treatment, payment or healthcare operations. The following includes some examples of uses and disclosures that fall under these categories, although not every use and disclosure is listed here.

We will only use and disclose your protected health information when we believe it necessary to conduct our business, or where use and disclosure is allowed or required by law. For example, protected health information may be used and disclosed to provide business services for us, such as helping to evaluate requests for insurance or benefits, performing general administrative activities, and assisting in processing transactions requested by you or for your benefit. Information may also be used and disclosed for such functions as claims administration; claims adjustment and management; detection, investigation or reporting of actual or potential fraud, misrepresentation or criminal activity; underwriting; policy placement or issuance; loss control; rate making and guaranty fund functions; reinsurance and excess loss insurance; risk management; case management; disease management; quality assurance; quality improvement; performance evaluation; provider credentialing verification; utilization review; peer review activities; actuarial, scientific, medical or public policy research; grievance procedures; internal administration of compliance, managerial and information systems; policyholder service functions; auditing; reporting; database security; administration of consumer disputes and inquiries; external accreditation standards; the replacement of a group benefit plan or workers compensation policy or program; activities in connection with a sale, merger, transfer or exchange of all or part of a business or operating unit; any activity that permits disclosure without authorization pursuant to the federal Health Insurance Portability and Accountability Act privacy rules promulgated by the U.S. Department of Health and Human Services; disclosure that is required, or is one of the lawful or appropriate methods, to enforce our rights or the rights of other persons engaged in carrying out a transaction or providing a product or service that a consumer requests or authorizes; and any activity otherwise permitted by law, required pursuant to governmental reporting or regulatory authority, or to comply with legal process. Additional insurance functions may be added to the extent they are necessary for appropriate performance of insurance functions and are fair and reasonable to the interest of our customers.

Except as otherwise permitted or required by law, use or disclosure of psychotherapy notes, use or disclosure of protected health information for certain types of marketing, and the sale of protected health information each require your written authorization. Other uses and disclosures not mentioned above will be made only with your written authorization. You may revoke your authorizations by writing to us at the address below. If you revoke the authorization, the revocation will not apply to any action COUNTRY Life Insurance Company^® or its service affiliate, CC Services, Inc., has taken on reliance of your initial authorization. The revocation also will not apply to our right to contest any claim made by you bearing on your health. Revocation of your authorization to us will severely limit the services and products we can provide to you.

If you have a group health plan, COUNTRY Life or CC Services may disclose protected health information to the sponsor of the plan, if any.

Your Protected Health Information Rights

Although your health record is the physical property of the health care practitioner of the facility that compiled it, the protected health information in it belongs to you. You have the right to:

request restrictions on certain uses and disclosures of protected health information. We are required to agree to a requested restriction if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, or if the protected health information pertains solely to a health care item or service for which you or person other than your health plan on your behalf has paid us in full. We are otherwise not required to agree to a requested restriction. If we do agree to a restriction, we may not use or disclose your protected health information in violation of that restriction, unless it is needed for an emergency.
receive confidential communications of protected health information by alternative means. We will accommodate reasonable requests to communicate with you about your protected health information by alternative means to alternative locations. If you would like us to communicate with you at an alternate address or by some other means, you must write to us at the address below and tell us in writing how you would like us to communicate with you. We will notify you in writing if we are not able to accommodate your request. This option applies only to our communications with you about your protected health information.
inspect and copy protected health information as provided by law. We may ask you to request such access in writing and to provide us specific information that will help us fulfill your request. We may charge you a reasonable fee based on the cost of copying and postage.
amend protected health information. All requests for amendment must be in writing. We have the right to deny your request for amendment if we did not create the information or for other reasons as allowed by law. All denials will be made in writing.
receive an accounting of disclosures of protected health information. At your written request, we will provide to you an accounting of our disclosures of your protected health information. We are not mandated to make an accounting of the following disclosures: (i) disclosures for treatment, payment and health care operations; (ii) disclosures permitted by law or specified herein; (iii) disclosures made in accordance with an authorization from you; (iv) other disclosures as specified by law such as disclosures for national security purposes.
obtain a paper copy of this notice from us upon request.

You may exercise any of these rights by notifying us in writing of your request at the address below.

Our Responsibilities

COUNTRY is required to:

maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information;
abide by the terms of this notice;
notify you if we are unable to agree to a requested restriction; and
comply with any reasonable request you may have to communicate protected health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you have supplied us. We will not use or disclose your protected health information without your authorization, except as described in this notice.

For More Information or to Report a Problem.

If you have questions or would like further information, you may contact COUNTRY Life at 1-866-COUNTRY, or by mail at: Corporate Insurance Compliance, Security and Recovery Department, Attn: HIPAA Privacy Officer, COUNTRY Life Insurance Company^®, P.O. Box 2000, Bloomington, Illinois 61702-2000.

If you believe your health privacy rights have been violated, you can file a complaint with us, in writing, at the above address. You may also file a complaint with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.