{"data":{"id":"us-oh/ohio-rev.-code-3904.06","jurisdiction":"us-oh","citation":"Ohio Rev. Code § 3904.06","heading":"Disclosure authorization form.","body":"No insurance institution, agent, or insurance support organization shall use as its disclosure authorization form in connection with insurance transactions a form or statement that authorizes the disclosure of personal or privileged information about an individual to the insurance institution, agent, or insurance support organization, unless the form or statement:\n(A) Is written in plain language;\n(B) Is dated;\n(C) Specifies the types of persons authorized to disclose information about the individual;\n(D) Specifies the nature of the information authorized to be disclosed;\n(E) Names the insurance institution or agent and identifies by generic reference representatives of the insurance institution to whom the individual is authorizing information to be disclosed;\n(F) Specifies the purposes for which the information is collected;\n(G) Specifies the length of time such authorization shall remain valid, which shall be no longer than:\n(1) In the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement, or a request for change in policy benefits, thirty months from the date the authorization is signed;\n(2) In the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy:\n(a) The term of coverage of the policy if the claim is for a health insurance benefit;\n(b) The duration of the claim if the claim is not for a health insurance benefit.\n(H) Advises the individual or a person authorized to act on behalf of the individual that the individual or the individual's authorized representative is entitled to receive a copy of the authorization form.","path":["Title 39 Insurance","Chapter 3904 Insurance Information Practices"],"source_url":"https://codes.ohio.gov/ohio-revised-code/section-3904.06","current_through":"1995-06-29 (House Bill 329 - 120th General Assembly)","vintage":"","retrieved_at":"2026-09-14T19:24:35Z","sha256":"5347e22dedfd8fe7654833c8415fd4e44f0dfb34cd605c966048cb2d70b2e755","source_id":"us-oh","stale":false,"prev":"us-oh/ohio-rev.-code-3904.05","next":"us-oh/ohio-rev.-code-3904.07"},"notice":"GroundRules: Original legal text. Not legal advice."}