1228 N Monroe Dr
Xenia, OH 45385
1228 N Monroe Dr
Xenia, OH 45385
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Brooker Family of Businesses
©2021 LeSourd Insurance. All Rights Reserved.
Brooker Insurance Agency, Inc. has always been committed to protecting the information you share with us. We are required by law to maintain the privacy of your personal information as well as your protected health information and to provide you with this Notice of Privacy Practices (“Notice”). This Notice describes our legal duties and privacy practices with respect to your information. This Notice applies to Brooker Insurance Agency, Inc. and any of its affiliated or subsidiary companies, including Brooker Insurance, Brooker Transportation, Brooker Mortgage, LeSourd & Company, Homer Yost Agency, Gulick Roberts, and Pelorus Brooker, all of which are herein called "Brooker Insurance."
PLEASE REVIEW THIS NOTICE CAREFULLY.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
This policy is effective as of October 2021. We reserve the right to change this policy from time to time. We will notify you about significant changes in the way we treat personal information by sending a notice to the primary email address that we have on file for you, and by placing a prominent notice on our site and this page. Your continued use of the site and/or services available through this site after such modification will constitute you acknowledgement of and agreement to said policy.
The Information We Gather
Brooker Insurance collects information from you on applications and other transactions with us. This information can include your name, contact information and identification numbers. It also may include medical history information for you and your dependents as well as medical information from insurance applications and claims submitted to us from your health care provider. We may also receive information from your employer if you participate in a group plan or from an insurance agent.
We primarily use your personal information to provide products and services to you. We will also use certain forms of personal information to enhance the operation of our Site, improve our internal marketing and promotional efforts, analyze and improve the Site. We may use your information to contact you regarding administrative notices.
We may also collect certain aggregate information, For example, we may use your IP address to diagnose problems with the server or to gather demographic information.
How We Use Your Information
We are permitted by law to use your information for certain purposes including payment, authorization of treatment, and administrative operations. The following are examples of how your information may be used:
Payment of Claims: Brooker Insurance may use or disclose your information to determine your coverage and to pay claims for healthcare you receive. We may provide eligibility information for treatments from your healthcare providers or use your information to obtain payment of premiums. We may also use your information to coordinate benefits and payment with other entities that have an obligation to pay for your healthcare.
Treatment: Brooker Insurance may use or disclose your information to aid in your treatment or to coordinate your care. We may provide your information to your health care provider.
Administrative Operations: Brooker Insurance may use or disclose your information for activities which are necessary to the operation of our business and the continued improvement of the quality of our service. Such uses include, but are not limited to, premium underwriting, data and information systems management, quality assessment and improvement, care coordination and management. If we use your information for underwriting purposes, we are prohibited by law from using or disclosing your genetic information for such purposes, and will not do so.
As required by law: Brooker Insurance must disclose your information to the Department of Health and Human Services if such information is requested during an audit of our records. Additionally, we may disclose your information if we are required to do so by law or certain public policy purposes. Examples of such requirements include, but are not limited to:
1. Compliance with a court order, subpoena or other legal order
2. Performance of mandatory reporting for licensing or compliance
3. Compliance with authorities for limited law enforcement purposes
4. Assistance with lawful intelligence, counterintelligence or national security activities
5. Compliance with public health authorities or health oversight agencies
6. Compliance with workers’ compensation and other similar programs for work related illness and injury, regardless of fault.
Business Associates: Brooker Insurance may disclose your information to third parties that we hire to assist in the administration of your benefits. These third parties are called Business Associates and they must agree in writing to protect and maintain the confidentiality and security of your information.
Plan Sponsors: If you receive insurance benefits through a group plan, Brooker Insurance may disclose to the plan sponsor, in summary form, claims history and other information about the group plan. This information will not disclose your name or other personally identifiable information. We may also disclose information regarding your enrollment or disenrollment in the plan. We may disclose your information to the plan sponsor for its administrative purposes, if the plan sponsor agrees in writing to ensure the continuing confidentiality and security of your information. The plan sponsor must also agree that such information will not be used for any employment or benefits related activities.
Other Disclosures: Brooker Insurance may also disclose your information:
1. To a personal representative appointed by you or designated by law
2. To appropriate military authorities, if you are a member of the armed forces
3. To a family member, friend or other person for the purpose of helping you with your healthcare or healthcare payment if you are in an emergency situation and you cannot give your agreement to Brooker Insurance to do this or if you have had an opportunity to object and have not done so
4. To provide you with appointment reminders and to inform you of treatment alternatives or other health related benefits or services that may be of interest to you.
With Permission: Brooker Insurance will not use or disclose your information for any purpose not outlined in this Notice unless you give us your written authorization to do so. Your authorization will be required for uses and disclosures of information for marketing purposes, and any disclosure that would constitute a sale of your information. You may revoke or amend your authorization at any time, but such revocation will not have any effect on actions which have already been taken with reliance on your previous authorization.
You have certain privacy and confidentiality rights as a customer of Brooker Insurance. Please note that all requests for information must be made in writing.
1. You may request additional restrictions on the use and disclosure of your information to carry out treatment, payment or other administrative actions. Brooker Insurance is not required to agree to your request.
2. You may request to have all communications with you regarding your information kept confidential. You may request a change in the method or location of communications. Brooker Insurance does not have to honor requests unless the request is reasonable, it allows us to continue to collect premiums and pay claims, or the request is necessary to avoid endangering you.
3. You have a right to have access to your medical and claims information. You may inspect and copy the information used and stored by Brooker Insurance. For access to your entire medical record, you will need to contact your service provider.
4. You have the right to request an amendment to your information. Brooker Insurance cannot amend information that it did not create.
5. You have a right to an accounting of certain disclosures made by Brooker Insurance or its Business Associates in the last six years.
6. You have the right to, and will receive, notification from us following a breach of your unsecured protected health information. Such notice will describe what happened, what information was involved and what steps you should take to protect yourself.
7. You have a right to receive a paper copy of this Notice.
8. You have a right to choose a representative to act for you. Brooker Insurance will verify that such representative has legal authority before we take any action.
9. You have the right to complain if you feel your rights have been violated. Complaints may be sent to Brooker Insurance. You also have the right to complain to the Secretary of the U.S. Department of Health and Human Services, Hubert Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. Federal law prohibits retaliation against you if you choose to file a complaint.
Brooker Insurance takes the security of your information very seriously and has established security standards and procedures to prevent unauthorized access to your information and comply with current industry standards. We maintain physical, technical and administrative safeguards to protect your information in any form, including oral, written and electronic, across the company.
You must be at least 18 years old to have our permission to use this site. Our policy is that we do not knowingly collect, use or disclose personally identifiable information about minor visitors.