California Notice of Right to Request Confidential Communications
Pursuant to Cal. Ins. Code § 791.29(b), you have the right to request that Fidelity Security Life Insurance Company® (FSL) through its Administrator, send all “Confidential Communications” regarding your vision insurance to you at an alternative address. For purposes of this Notice, “Confidential Communications” refer to all communications that disclose your medical information or provider name and address related to your Vision insurance and related medical services.
Examples of Confidential Communications may include all bills and attempts to collect payment, notice of adverse benefits determinations, explanation of benefits notices, requests for additional information concerning a claim, notices of contested claims, names and addresses of providers, descriptions of services provided, any information related to a visit, and any other written, oral, or electronic communication containing medical information related specifically to your vision insurance.
FSL’s designated administrator will respond to your request and provide directions and a form to complete no later than 7 business days after the date of receipt of a request by email, or no later than 14 days after the date of receipt by mail. The Confidential Communication request will be valid until you submit a revocation of the request, or a new Confidential Communication request is submitted.
To request to receive Confidential Communications at an alternative address please submit your name and address, your policy/certificate number shown on your Vision Insurance ID card, and your phone and/or email address to the following:
Avesis Third Party Administrators, LLC
Email to: accountmanager@avesis.com
Mail to: Avesis Third Party Administrators, LLC
10400 N. 25th Avenue, Suite 200
Phoenix, AZ 85021
EyeMed Vision Care, LLC
Email to: privacyoffice@eyemed.com
Fidelity Security Life Insurance Company
Email to: compliance@fslins.com
Mail to: Privacy Office
Fidelity Security Life Insurance Company
P.O. Box 418131
Kansas City, MO 64141-8131