Privacy Statement and Compensation Statement

PURPOSE OF THIS NOTICE
In compliance with the Gramm-Leach-Bliley Act (GLBA) and California law, we are providing you with this document, which notifies you of the privacy policies and practices of Leap/Carpenter/Kemps Insurance Agency. Our Company recognizes that the foundation of our business is the trust and confidence of our policyholders. In order to provide you the most effective and beneficial service, we must maintain information about you. Keeping policyholder information secure and private is important to us. This notice is provided to you so that you may know how we collect information about you, the type of information we collect, what we may disclose to our affiliates and nonaffiliated third parties, and the steps we take to protect your personal information.

WHAT WE COLLECT
First, we must collect a certain amount of your personal information in order to provide your insurance, customer service, offer new products or services, evaluate benefits and claims, administer our products, and fulfill legal and regulatory requirements. Therefore, we must obtain certain nonpublic personal information about you. This information includes:

  • Information that you provide us on applications and other forms, such as your name, address, date of birth, Social Security number, gender, marital status, occupation(s), employer(s) and financial information.
  • Information about your transactions with us from the insurance companies we contact to underwrite your insurance such as your relationship with us, products or services purchased, policy values, payment history and claims history.
  • Information we receive from consumer reporting agencies such as motor vehicle reports, credit histories, inspection reports, and loss histories.
  • Information contained in medical records or from medical professionals that is related to insurance claims.
  • Information we receive from your professional representatives such as attorneys, accountants and other financial service providers.

WHAT WE SHARE
We do not disclose information about you to third parties whose only use of the information is to market a product or service. However, in the course of our general business practices, we may disclose the information that we collect (as described above) about you or others without your permission to the following types of institutions for the reasons described below:

  • To a third party if the disclosure will enable that party to perform a business, professional or insurance function for us.
  • To an insurance institution, agent or credit-reporting agency for either this agency or the entity to which we disclose the information to perform a function in connection with an insurance transaction involving you.
  • To a medical care institution or medical professional in order to verify coverage or benefits, inform you of a medical problem of which you may not be aware, or conduct an audit that would enable us to verify treatment.
  • To the California Department of Insurance or other insurance regulatory authority, law enforcement, or other governmental authority in order to protect our interests in preventing or prosecuting fraud.
  • To a group policyholder for the purpose of reporting claims experience or conducting an audit of our operations or service.

SECURITY MEASURES
Our practices regarding information confidentiality and security with respect to the information we collect about you:

  • We collect and use the information to the extent needed to conduct our business and to meet high quality service standards.
  • We restrict access to the information to authorized individuals who need to know this information to provide service and products to you.
  • We maintain physical, electronic, and procedural safeguards that protect your information.
  • We will verify that any persons requesting information about you or your relationship with us is entitled to such information prior to providing it. For example, we may give information to heirs/beneficiaries concerning the existence and amount of life insurance and annuity contracts following the receipt of notice of the death of an insured or an annuitant.
  • We share non-public personal information about you outside our company only to service your request, or as authorized by you, or as required or permitted by applicable law.
  • We require any organization that provides assistance to us in administering or reinsuring our contracts or providing services on our behalf to you to maintain the confidentiality of your non-public personal information and not to use such information for any other purpose.

RIGHT TO DISCLOSE INFORMATION IN UNFORESEEN CIRCUMSTANCES
In connection with the potential sale or transfer of its interests, Leap/Carpenter/Kemps Insurance Agency, and its affiliates (if any), reserve the right to sell or transfer your information (including but not limited to your name, address, age, sex, zip code, state and country of residency, and other information that you provide through other communications) to a third party entity that concentrates its business in a similar practice, product or service; agrees to be Leap/Carpenter/Kemps’ successor in interest with regard to the maintenance and protection of the information collected; and agrees to the obligations of this privacy statement.

YOUR RIGHT TO ACCESS PERSONAL INFORMATION
You have the right to request access to the personal information that we record about you. Your right includes the right to know the source of the information and the identity of the persons, institutions or types of institutions to whom we have disclosed such information within two years prior to your request. Your right includes the right to view such information and obtain a copy of it. Your right also includes the right to request corrections, amendments or deletions of any information that is in our possession by contacting us at the following address:

Leap/Carpenter/Kemps Insurance Agency Attention:
Operations Manager
P.O. Box
1512 Merced, CA 95341

PRIOR CUSTOMERS
If you cease to be our customer, our Privacy Policy, as amended from time to time, will continue to apply to the extent that we retain information about you that we collected while you were our customer.

ADDITIONAL INFORMATION
If we change our privacy practices, we will provide you notice of all material changes. This privacy notice supercedes all previous notices with respect to matters described herein.

No action is required by you. You do not need to do anything as a result of this notice. It is meant to inform you of how we safeguard your nonpublic personal information. You may wish to file this notice with your insurance papers.
Your trust and confidence is important to us and we strive to maintain your continued trust.
If you have any questions concerning this notice, please call our Operations Manager at (209) 384-0727.
HIPAA Notice
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.

STATEMENT OF OUR DUTIES
We are required by law to maintain the privacy of your personal health information and to provide you with this notice of our privacy practices and legal duties. We are required to abide by the terms of this notice. We reserve the right to change the terms of this notice and to make any new provisions effective to all of the personal health information that we maintain about you. If we revise this notice, we will provide you with a revised notice by mail.

STATEMENT OF YOUR RIGHTS
You have a right to know how we may use or disclose your personal health information. This notice informs you of those uses and disclosures. There are certain uses and disclosures of your personal health information that we are permitted or required to make by law without your permission. For all other uses and disclosures, we first must obtain your permission. In addition, you have the following rights:

  • The right to request that we place additional restrictions on our uses and disclosures of your personal health information. However, we are not obligated to agree to impose any such additional restrictions.
  • The right to access, inspect and copy the protected information pertaining to you that we maintain in our files about you, and the right to have us correct or amend any information that we create in error. Requests to access or amend your health information should be sent to the contact person and address provided in paragraph six.
  • The right to receive an accounting of the disclosures of your personal health information that we make for purposes other than activities related to your treatment, or our payment functions or other health care operations.
  • The right to request that you receive communications of personal health information in a confidential manner.
  • The right to obtain a paper copy of this notice from us on request.

INFORMATION WE COLLECT ABOUT YOU
We collect the following categories of information about you from the following sources:

  • Information that we obtain directly from you, in conversations or on applications or other forms that you fill out.
  • Information that we obtain as a result of our transactions with you.
  • Information that we obtain from your medical records or from medical professionals.
  • Information that we obtain from other entities, such as health care providers or other insurance companies, in order to service your policy or carry out other insurance-related needs.

PERMISSIBLE USES AND DISCLOSURES OF PROTECTED INFORMATION

  • To Carry Out Treatment Functions. We may use or disclose your health information without your permission for health care providers to provide you with treatment.
  • To Carry Out Payment Functions. We may use or disclose your health information without your permission to carry out activities relating to reimbursing you for the provision of health care, obtaining premiums, determining coverage, and providing benefits under the policy of insurance that you are purchasing. Such functions may include reviewing health care services with respect to medical necessity, coverage under the policy, appropriateness of care, or justification of charges.
  • To Carry Out Certain Operations Relating To Your Benefit Plan. We also may use or disclose your protected health information without your permission to carry out certain limited activities relating to your health insurance benefits, including reviewing the competence or qualifications of health care professionals and conducting quality assessment activities.
  • In Situations Permitted Or Required By Law.We also may use or disclose your protected health information without your written permission for other purposes permitted or required by law, including:
    • As authorized by and to the extent necessary to comply with workers compensation or other no-fault laws.
    • To a health oversight agency for activities including audits or civil, criminal or administrative proceedings.
    • To a public health authority for purposes of public health activities (such as to the Food and Drug Administration to report consumer product defects).
    • To a law enforcement official for law enforcement purposes or in response to a court order or in the course of any judicial or administrative proceeding.
    • To organ procurement organizations, or to other entities for approved research purposes.
    • To a government authority, including a social service or protective services agency, authorized to receive reports of abuse, neglect or domestic violence.
  • To Carry Out Treatment Functions. We may use or disclose your health information without your permission for health care providers to provide you with treatment.

COMPLAINTS ABOUT MISUSE OF HEALTH INFORMATION
You may complain either directly to us or to the Secretary of Health and Human Services if you believe that your rights with respect to our protection of your health information have been violated. To file a complaint with us, you may submit a letter in writing that includes as many details as possible including any names and dates to assist with investigating your complaint. You will not be retaliated against in any way for filing a complaint.

OUR POLICY REGARDING DISPUTE RESOLUTION
Any controversy or claim arising out of or relating to our privacy policy, or the breach thereof, shall be settled by arbitration in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof.

CONTACT PERSON FOR FILING COMPLAINT OR OBTAINING FURTHER INFORMATION
David Cribb, Privacy Officer
Leap/Carpenter/Kemps Insurance Agency
3187 Collins Dr.
Merced, CA 95348
(209) 384-0727, ext. 311
dcribb@lckinsurance.com

 

Compensation Notice

You are a highly valued customer, and our firm takes pride in the services we provide to you.

Acting as an independent insurance agent or as an insurance broker, we are able to offer you professional service and competitive prices because we can access insurance coverage, in most cases, from more than one insurance company.

Our compensation is based on ONE of the following:

  • Our firm is paid a commission for selling and servicing your account. The amount is based on the standard commission schedules established by each of the companies we work with.

or

  • The insurance company with which your policy is being placed does NOT pay this firm for the placement. Our sole compensation is the Broker Fee, which has previously been disclosed to you, and to which you have given your consent.

or

  • In addition to the Broker Fee we are charging you, which has previously been disclosed to you, and to which you have given your consent, we also receive compensation from the insurance company in the form of a sales commission described generally above.

Our firm may also be eligible, and in some cases, is eligible, for various forms of incentive compensation, including contingent commissions and other awards and bonuses, from the insurer. Incentive compensation is based upon a variety of factors that may include the level of premium written, retention, growth, overall profitability, or other performance measures established by the insurers with whom we do business.

Our firm will attempt to obtain one or more quotes for insurance coverage suitable for the needs and preferences you have communicated to us, and will provide you with the quotes we obtain that we believe suit your needs. Please remember, however, that you are ultimately responsible for determining what coverages you need for your protection, the amount of insurance you need and other issues.

We are happy to provide you with additional details about our services, our relationship with your insurance company or our compensation.

Our agency is grateful to have you as a customer, and we welcome any suggestions you have to assist us in serving you better. We appreciate your business.

 

 

Dedicated to Finding You the Best Coverage!