Consent for Use and Processing of Protected Health Information (PHI)

By proceeding to submit a complaint, inquiry, or contact request through this website, you (“the Member” or “the Data Subject”) expressly acknowledge and provide your informed consent to the collection, use, processing, storage, and disclosure of your Protected Health Information (PHI) by [Company Name] (“the Company”), in accordance with applicable data protection, healthcare, and insurance regulations.

Purpose of Collection and Use

The PHI and personal data provided by you through this platform may include, but is not limited to, your name, contact details, policy information, medical details, and any other health-related information necessary to:

• Register, review, and respond to your complaint or inquiry

• Verify your identity and policy eligibility

• Investigate, process, and resolve insurance-related matters

• Comply with regulatory, legal, and audit obligations imposed by relevant authorities

Lawful Basis and Confidentiality

Your PHI will be processed strictly on a need-to-know basis and solely for the purposes stated above. The Company undertakes to handle all PHI with the highest level of confidentiality and security, applying appropriate administrative, technical, and physical safeguards to prevent unauthorized access, disclosure, alteration, or misuse.

Disclosure to Third Parties

Where necessary for complaint resolution or regulatory compliance, your PHI may be shared with:

• Authorized internal departments

• Healthcare providers, third-party administrators, or insurers

• Regulatory or supervisory authorities
  Such disclosures shall be limited to the minimum information required and conducted in compliance with applicable laws and contractual obligations.

Data Retention

Your PHI will be retained only for the duration required to fulfill the stated purposes or as mandated by applicable laws and regulatory requirements, after which it will be securely disposed of or anonymized.

Voluntary Consent and Right to Withdraw

Providing your PHI through this website is voluntary. However, failure to provide the required information may result in the Company being unable to process or respond to your complaint or inquiry.
You retain the right to withdraw your consent at any time by submitting a written request to [Data Protection Contact / Email], subject to legal or regulatory retention obligations.

Acknowledgement

By selecting the consent checkbox and submitting your details, you confirm that:

• You have read and understood this consent statement

• You voluntarily agree to the use and processing of your PHI as described above

• The information provided by you is accurate and complete to the best of your knowledge