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Privacy Notice and Authorization Form
  Home > Senior Insurance > Customers > My Plan > Privacy Notice and Authorization Form 




We respect your right to privacy.  Click here  to see our current privacy notice. 

NOTE: Adobe Acrobat Reader 5.0 is required.

Except as outlined in the privacy notice, we will not use or disclose your personal information unless you have signed a form authorizing the use or disclosure. 

For an authorization form contact a Customer Service Representative at 1-866-459-4272.


 
   
© 2005 Provident American Life & Health Insurance Company, All Rights Reserved    Legal Disclaimer  -  Privacy Notice 
PALHICWS-1558-(10/14/05)