Delta Dental Ppo - Plus Premier Federally Compliant Plans Enrollment Form (Page 2 of 2) in pdf

Delta Dental of Oklahoma

All companies part of the Delta Dental of Oklahoma family of companies (referred to in this Privacy Policy as “Delta Dental”) believe that personal information collected about

our customers, subscribers, potential customers, and proposed subscribers (referred to collectively in this Privacy Policy as “Customers”) must be treated with the highest

degree of confidentiality. For this reason and in compliance with the Gramm-Leach-Bliley Act of 1999, Delta Dental has developed a Privacy Policy that applies to all employees,

officers, directors, agents, brokers, and to any other transaction Delta Dental has which may contain your confidential information. Financial companies are able to choose how

they share your personal information; however Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect,

share, and protect your personal information. Please read this notice carefully to understand what we do.

Information We Collect – We collect and maintain personal, nonpublic information we receive from Customers directly, through applications, enrollment forms, check, credit or

debit card payments, insurance claims, and our website. We also collect your personal information from other companies. The types of personal information we collect and

share depend on the product or service you have with us. This information can include your name, address, social security number, date of birth, transaction and claim history,

medical information, and checking account information.

Utilization Of Information – Delta Dental has, and will continue to utilize non-affiliated third parties to conduct certain functions of our business in order to provide our

Customers with services and products. These functions include processing your requests, claims and transactions, maintaining your account(s), providing information about new

products, responding to court orders and legal investigations, reporting to credit bureaus, and to comply with Federal and State Laws. The information Delta Dental uses to

provide a service cannot be restricted by our Customers. However, Delta Dental is able to limit this information on your behalf under HIPAA.

Federal law gives consumers the right to limit information sharing in relation to affiliates’ everyday business purposes, information about your creditworthiness, affiliates using

your information to market to you, and non-affiliates using your information to market to you. In addition, state laws and other individual companies may give you additional

rights to limit sharing.

Delta Dental does not have any affiliates, nor do we share information with non-affiliates for marketing purposes. When you are no longer our Customer, we will continue to

share your information as described in this notice.

Our Security - To protect your personal information from unauthorized access and use, we maintain physical, electronic, and procedural safeguards that comply with

Federal Law, including computer safeguards and secured files and buildings. We consider nonpublic personal information to be confidential, and treat it as such. The personnel

who have access to this information are trained in proper handling of such information. Employees who violate this strict level of confidentiality are subject to our

disciplinary process.

While we do make available certain nonpublic personal information to non-affiliated third parties in order to service Customer accounts, all information is strictly governed by

confidentiality and security agreements to protect our Customers. Therefore, our Customer’s confidential information is protected.

If the group plan is terminated or you terminate your coverage, Delta Dental will adhere to the information practices as described in this notice.

If you have any questions about our Privacy Policy, please do not hesitate to contact your Delta Dental representative at 800-522-0188 (Toll Free) or 405-607-2100 (OKC Metro).

Under no circumstances will we sell information about our Customers or their account to any unaffiliated company, group, or individual without our Customer’s permission.

Revised 06/2010

Delta Dental Ppo - Plus Premier Federally Compliant Plans Enrollment Form Page 2

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