§ 58-39-75. Disclosure limitations and conditions. - North Carolina Statutes

§ 58‑39‑75. Disclosure limitations and conditions.

An insurance institution,agent, or insurance‑support organization shall not disclose any personalor privileged information about an individual collected or received inconnection with an insurance transaction unless the disclosure is:

(1)        With the writtenauthorization of the individual, provided:

a.         If suchauthorization is submitted by another insurance institution, agent, orinsurance‑support organization, the authorization meets the requirementsof G.S. 58‑39‑35; or

b.         If suchauthorization is submitted by a person other than an insurance institution,agent, or insurance‑support organization, the authorization meets therequirements of G.S. 58‑39‑35 and is:

1.         Dated;

2.         Signed by theindividual; and

3.         Obtained one year orless before the date a disclosure is sought pursuant to this paragraph; or

(2)        To a person otherthan an insurance institution, agent, or insurance‑support organization,provided such disclosure is reasonably necessary:

a.         To enable thatperson to perform a business, professional, or insurance function for thedisclosing insurance institution, agent, or insurance‑supportorganization, including, but not limited to, performing marketing functions andother functions regarding the provision of information concerning thedisclosing institution's own products, services, and programs, and that personagrees not to disclose the information further without the individual's writtenauthorization unless the further disclosure:

1.         Would otherwise bepermitted by this section if made by an insurance institution, agent, orinsurance‑support organization; or

2.         Is reasonablynecessary for that person to perform its function for the disclosing insuranceinstitution, agent, or insurance‑support organization; or

b.         To enable thatperson to provide information to the disclosing insurance institution, agent,or insurance‑support organization for the purpose of:

1.         Determining anindividual's eligibility for an insurance benefit or payment; or

2.         Detecting orpreventing criminal activity, fraud, material misrepresentation, or materialnondisclosure in connection with an insurance transaction; or

(3)        To an insuranceinstitution, agent, insurance‑support organization, or self‑insurer,provided the information disclosed is limited to that which is reasonablynecessary:

a.         To detect or preventcriminal activity, fraud, material misrepresentation, or material nondisclosurein connection with insurance transactions; or

b.         For either thedisclosing or receiving insurance institution, agent, or insurance‑supportorganization to perform its function in connection with an insurancetransaction involving the individual; or

(4)        To a medical‑careinstitution or medical professional for the purpose of (i) verifying insurancecoverage or benefits, (ii) informing an individual of a medical problem ofwhich the individual may not be aware, or (iii) conducting an operations orservices audit, provided only such information is disclosed as is reasonablynecessary to accomplish the foregoing purposes; or

(4a)      (Effective October1, 2010) To a person making an inquiry under G.S. 58‑58‑97 whenproviding funeral service to a deceased insured; or

(5)        To an insuranceregulatory authority; or

(6)        To a law‑enforcementor other government authority:

a.         To protect theinterests of the insurance institution, agent, or insurance‑supportorganization in preventing or prosecuting the perpetration of fraud upon it; or

b.         If the insuranceinstitution, agent, or insurance‑support organization reasonably believesthat illegal activities have been conducted by the individual; or

(7)        Otherwise permittedor required by law; or

(8)        In response to afacially valid administrative or judicial order, including a search warrant orsubpoena; or

(9)        Made for the purposeof conducting actuarial or research studies, provided:

a.         No individual may beidentified in any actuarial or research report;

b.         Materials allowingthe individual to be identified are returned or destroyed as soon as they areno longer needed; and

c.         The actuarial orresearch organization agrees not to disclose the information unless thedisclosure would otherwise be permitted by this section if made by an insuranceinstitution, agent, or insurance‑support organization; or

(10)      To a party or a representativeof a party to a proposed or consummated sale, transfer, merger, orconsolidation of all or part of the business of the insurance institution,agent, or insurance‑support organization, provided:

a.         Prior to theconsummation of the sale, transfer, merger, or consolidation only suchinformation is disclosed as is reasonably necessary to enable the recipient tomake business decisions about the purchase, transfer, merger, or consolidation,and

b.         The recipient agreesnot to disclose the information unless the disclosure would otherwise bepermitted by this section if made by an insurance institution, agent orinsurance‑support organization; or

(11)      To a person whoseonly use of such information will be in connection with the marketing of aproduct or service, provided:

a.         No medical‑recordinformation, privileged information, or personal information relating to anindividual's character, personal habits, mode of living, or general reputationis disclosed, and no classification derived from such information is disclosed;

b.         The individual hasbeen given an opportunity to indicate that he does not want personalinformation disclosed for marketing purposes and has given no indication thatsuch individual does not want the information disclosed; and

c.         The person receivingsuch information agrees not to use it except in connection with the marketingof a product or service; or

(12)      To an affiliate whoseonly use of the information will be in connection with an audit of theinsurance institution or agent or the marketing of an insurance product orservice, provided the affiliate agrees not to disclose the information for anyother purpose or to unaffiliated persons; and further provided that no medicalrecord information may be disclosed to the affiliate for the marketing of aninsurance product or service; or

(13)      By a consumerreporting agency, provided the disclosure is to a person other than aninsurance institution or agent; or

(14)      To a grouppolicyholder for the purpose of reporting claims experience or conducting anaudit of the insurance institution's or agent's operations or services,provided the information disclosed is reasonably necessary for the grouppolicyholder to conduct the review or audit; or

(15)      To a professionalpeer review organization for the purpose of reviewing the service or conduct ofa medical‑care institution or medical professional; or

(16)      To a governmentalauthority for the purpose of determining the individual's eligibility forhealth benefits for which the governmental authority may be liable; or

(17)      To a certificateholder or policyholder for the purpose of providing information regarding thestatus of an insurance transaction; or

(18)      To a lienholder,mortgagee, assignee, lessor, or other person shown on the records of an insuranceinstitution or agent as having a legal or beneficial interest in a policy ofinsurance only if:

a.         No medical recordinformation is disclosed unless the disclosure would otherwise be permitted bythis section; and

b.         The informationdisclosed is limited to that which is reasonably necessary to permit suchperson to protect its interest in such policy; or

(19)      To authorizedpersonnel of the Division of Motor Vehicles upon requests pursuant to G.S. 20‑309(c)or G.S. 20‑309(f).

(20)      To the Department ofHealth and Human Services and the information disclosed is immunizationinformation described in G.S. 130A‑153.

(21)      To a person whoseonly use of an applicant's or policyholder's personal information, but notincluding medical record information, will be in connection with the marketingof a financial product or service intended to be provided by participants in amarketing program where the program participants and the types of informationto be shared are identified to the applicant or policyholder when the applicantor policyholder is first offered the financial product or service. As used inthis subdivision:

a.         "Financialinstitution" means any institution the business of which is engaging inactivities that are financial in nature or incidental to such financialactivities as described in section 4(k) of the Bank Holding Company Act of 1956(12 U.S.C. § 1843(k)).

b.         "Financialproduct or service" means any product or service that a financial holdingcompany could offer by engaging in an activity that is financial in nature orincidental to such financial activity under section 4(k) of the Bank HoldingCompany Act of 1956 (12 U.S.C. § 1843(k)).

c.         "Marketingprogram" includes only those programs established by written agreement bythe insurance institution and one or more financial institutions under whichthey jointly offer, endorse, or sponsor a financial product or service.  (1981, c. 846, s. 1; 1985,c. 666, s. 68; 1993, c. 134, s. 2; 1997‑443, s. 11A.20A; 2001‑351,ss. 7, 8, 10, 11, 12; 2003‑262, s. 2(1); 2009‑566, s. 24.)