Wisconsin Administrative Code
Office of the Commissioner of Insurance
Chapter Ins 25 - Privacy Of Consumer Financial And Health Information
Appendix A - SAMPLE CLAUSES
Licensees, including a group of financial holding company affiliates that use a common privacy notice, may use the following sample clauses, if the clause is accurate for each institution that uses the notice. (Note that disclosure of certain information, such as assets, income and information from a consumer reporting agency, may give rise to obligations under the federal Fair Credit Reporting Act, such as a requirement to permit a consumer to opt out of disclosures to affiliates or designation as a consumer reporting agency if disclosures are made to nonaffiliated third parties.)
A-1-Categories of information a licensee collects (all institutions)
A licensee may use this clause, as applicable, to meet the requirement of s. Ins 25.15(1) (a) to describe the categories of nonpublic personal financial information the licensee collects.
Sample Clause A-1:
We collect nonpublic personal financial information about you from the following sources:
* Information we receive from you on applications or other forms;
* Information about your transactions with us, our affiliates or others; and
* Information we receive from a consumer reporting agency.
A-2-Categories of information a licensee discloses (institutions that disclose outside of the exceptions)
A licensee may use one of these clauses, as applicable, to meet the requirement of s. Ins. 25.15(1) (b) to describe the categories of nonpublic personal financial information the licensee discloses. The licensee may use these clauses if it discloses nonpublic personal financial information other than as permitted by the exceptions in ss. Ins 25.50, 25.55, and 25.60.
Sample Clause A-2, Alternative 1:
We may disclose the following kinds of nonpublic personal financial information about you:
* Information we receive from you on applications or other forms, such as [provide illustrative examples, such as "your name, address, social security number, assets, income, and beneficiaries"];
*Information about your transactions with us, our affiliates or others, such as [provide illustrative examples, such as "your policy coverage, premiums, and payment history"]; and
* Information we receive from a consumer reporting agency, such as [provide illustrative examples, such as "your creditworthiness and credit history"].
Sample Clause A-2, Alternative 2:
We may disclose all of the information that we collect, as described [describe location in the notice, such as "above" or "below"].
A-3-Categories of in formation a licensee discloses and parties to whom the licensee discloses (institutions that do not disclose outside of the exceptions)
A licensee may use this clause, as applicable, to meet the requirements of s. Ins 25.15(1) (b), (c) and (d) to describe the categories of nonpublic personal financial information about customers and former customers that the licensee discloses and the categories of affiliates and nonaffiliated third parties to whom the licensee discloses. A licensee may use this clause if the licensee does not disclose nonpublic financial personal information to any party, other than as permitted by the exceptions in ss. Ins 25.55 and 25.60.
Sample Clause A-3:
We do not disclose any nonpublic personal financial information about our customers or former customers to anyone, except as permitted by law.
A-4-Categories of parties to whom a licensee discloses (institutions that disclose outside of the exceptions)
A licensee may use this clause, as applicable, to meet the requirement of s. Ins 25.15(1) (c) to describe the categories of affiliates and nonaffiliated third parties to whom the licensee discloses nonpublic financial personal information. This clause may be used if the licensee discloses nonpublic financial personal information other than as permitted by the exceptions in ss. Ins 25.50, 25.55, and 25.60, as well as when permitted by the exceptions in ss. Ins 25.55 and 25.60.
Sample Clause A-4:
We may disclose nonpublic financial personal information about you to the following types of third parties:
*Financial service providers, such as [provide illustrative examples, such as "life insurers, automobile insurers, mortgage bankers, securities broker-dealers, and insurance agents"];
*Non-financial companies, such as [provide illustrative examples, such as "retailers, direct marketers, airlines, and publishers"]; and
*Others, such as [provide illustrative examples, such as "non-profit organizations"].
We may also disclose nonpublic financial personal information about you to nonaffiliated third parties as permitted by law.
A-5-Service provider/joint marketing exception
A licensee may use one of these clauses, as applicable, to meet the requirements of s. Ins 25.15(1) (e) related to the exception for service providers and joint marketers in s. Ins 25.50. If a licensee discloses nonpublic personal financial information under this exception, the licensee shall describe the categories of nonpublic financial personal information the licensee discloses and the categories of third parties with which the licensee has contracted.
Sample Clause A-5, Alternative 1:
We may disclose the following information to companies that perform marketing services on our behalf or to other financial institutions with which we have joint marketing agreements:
*Information we receive from you on applications or other forms, such as [provide illustrative examples, such as "your name, address, social security number, assets, income, and beneficiaries"];
*Information about your transactions with us, our affiliates or others, such as [provide illustrative examples, such as "your policy coverage, premium, and payment history"]; and
*Information we receive from a consumer reporting agency, such as [provide illustrative examples, such as "your creditworthiness and credit history"].
Sample Clause A-5, Alternative 2:
We may disclose all of the information we collect, as described [describe location in the notice, such as "above" or "below"] to companies that perform marketing services on our behalf or to other financial institutions with whom we have joint marketing agreements.
A-6-Explanation of opt out right (institutions that disclose outside of the exceptions)
A licensee may use this clause, as applicable, to meet the requirement of s. Ins 25.15(1) (f) to provide an explanation of the consumer's right to opt out of the disclosure of nonpublic personal financial information to nonaffiliated third parties, including the method(s) by which the consumer may exercise that right. The licensee may use this clause if the licensee discloses nonpublic personal financial information other than as permitted by the exceptions in ss. Ins 25.50, 25.55, and 25.60.
Sample Clause A-6:
If you prefer that we not disclose nonpublic personal financial information about you to nonaffiliated third parties, you may opt out of those disclosures, that is, you may direct us not to make those disclosures (other than disclosures permitted by law). If you wish to opt out of disclosures to nonaffiliated third parties, you may [describe a reasonable means of opting out, such as "call the following toll-free number: (insert number)].
A-7-Confidentiality and security (all institutions)
A licensee may use this clause, as applicable, to meet the requirement of s. Ins 25.15(1) (g) to describe its policies and practices with respect to protecting the confidentiality and security of nonpublic personal financial information.
Sample Clause A-7:
We restrict access to nonpublic personal financial information about you to [provide an appropriate description, such as "those employees who need to know that information to provide products or services to you"]. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal financial information.
