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Fill and Sign the Hic Microsoft Registration Form

Fill and Sign the Hic Microsoft Registration Form

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MUTUAL OF OMAHA PRIVACY NOTICE—MEDICAL INFORMATION ATTACHMENT FOR RESIDENTS OF NEVADA Genetic Information: We will not require an enrollee or any member of his family to take a genetic test, disclose whether he or a member of his family has taken a genetic test, or disclose any genetic information, except as permitted by Nevada law. We will not use genetic information to determine the rates or any other aspect of the coverage or benefits for health care provided to an insured person, except as permitted by Nevada law. it must be obtained one year or less prior to the date of disclosure. Access/Accounting: You have a right of access to recorded personal information we have about you. We will respond to your request for access or an accounting within 30 business days from the date your request is received. We will inform you of the nature and substance of such recorded personal information. Group and Blanket Health Insurance: We will not disclose to the policyholder or any agent or employee of the policyholder the fact that an insured is taking a prescribed drug or medicine or the identity of that drug or medicine, except as permitted by Nevada law. Authorizations to Disclose Medical Information: If we request an authorization that permits disclosure of medical information to another insurance institution, insurance agent or insurance support organization, it shall remain valid for not longer than 30 months, or if we obtain the authorization for claim purposes, for the term of the related insurance coverage. If we request an authorization that permits disclosure of medical information to a person other than an insurance institution, insurance agent or insurance support organization, MC20368_NV You have a right to receive an accounting of disclosures of your personal information that we have made within two years prior to the request for the accounting, whether the disclosure was made before or after April 14, 2003. Under your state’s law, you are entitled to an accounting of disclosures to carry out our payment or health care operations. Amendments: We will respond to your written request to correct, amend, or delete any recorded personal information about you within our possession within 30 business days after the postmark of a written request.

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  3. Open your ‘Hic Microsoft Registration Form’ in the editor.
  4. Click Me (Fill Out Now) to finalize the form on your end.
  5. Add and designate fillable fields for others (if necessary).
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