Request Information
To receive information and/or a personal quote on long-term care insurance, please fill in the following information as completely as possible. Items with a * are required.
If you are filling out this form for someone else (i.e. your parents) please enter their information on the form.
*Name:
*Address:
*City:
*State:
*Zip Code:
*Phone:
Fax:
*E-Mail:
*Your Birthdate:
*If married, your Spouse’s Birthdate:
Have you or your spouse ever been declined for long-term care insurance?
You:
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Spouse:
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PRIVACY POLICY
We collect personally identifiable information from consumers including name, address, zip code, e-mail address, and date of birth when provided. We use this information to solicit business for the products we market through our insurance agents selling products we promote. We do not share information with third parties for marketing purposes. Consumers may review, correct, or delete information about themselves at any time with proper authentication by requesting to be put on our do not call list, or by sending an e-mail stating they wish to opt out to info@goldencareusa.com.
We strive to maintain our A+ rating with the Better Business Bureau and work hard to stay in compliance with the most current laws and update our policies when necessary. When updates are made to the privacy policy, changes will be located on the website and/or via e-mail if the consumer has provided an e-mail address to us.
We have put in place security measures to protect your personal information by encrypting and protecting computers with passwords. We have made efforts to encrypt all electronic private health information sent out and limit uses, disclosures, and requests for PHI to only those entities which the consumer has given us permission to share. We also train our agents and employees on HIPAA rules and provide refresher training on a regular basis as an effort to enforce and comply with applicable laws. We also have security measures such as alarm systems and locked areas to maintain the confidentiality of private information.
Should you have any other questions or concerns about this privacy policy please call us at 800-842-7799 or send us an e-mail at info@goldencareusa.com. We will be happy to assist you.
Policy effective: July 2009.
