Should you wish to request such confidentiality, you may send a written request to Security Mutual Life Insurance Company of New York, 100 Court Street, Binghamton, New York, 13901, Attn: Privacy Officer. Your request should include the following information:
- The name of the individual for whom confidentiality is requested. A child’s parent or
guardian may make such a request on behalf of a minor child;
- The policy or certificate number to which the request is related, if known;
- A statement that disclosure of all or part of the information to which the request pertains
could endanger the individual;
- The alternative address, telephone number or other method of contact for the protected individual;
- A copy of the order of protection, if any.
Should your request relate to health insurance, you may use the Confidential Communication Request Formto provide this information.
Should you later wish to revoke your request, please send a sworn statement to the Company’s Privacy Officer at the address given above.
The New York State Domestic and Sexual Violence Hotline can be reached at:
Spanish language 1-800-942-6908
In NYC: 1-800-621-HOPE (4673) or dial 311