Confidentiality for Victims of Domestic Violence and Endangered Individuals

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The New York Department of Financial Services has in force Regulation 168, Confidentiality Protocols for Victims of Domestic Violence and Endangered Individuals. This regulation implements Section 2612 of the New York Insurance Law, which establishes procedures by which a victim of domestic violence or potentially endangered individual may request that his or her address, telephone number and certain other information be kept confidential and not disclosed to the policyowner. The specific provisions vary depending on the type of insurance involved. Please see http://www.dfs.ny.gov/insurance/insurers/confordm.htm.

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 Form to 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:

1-800-942-6906
Spanish language 1-800-942-6908

In NYC: 1-800-621-HOPE (4673) or dial 311
TTY: 1-866-604-5350
http://www.opdv.ny.gov/help/dvhotlines.html