Senior Dental Coverage - Blue Cross Blue Shield of Georgia

If you do not receive a contract within 60 days,please contact Blue Cross and Blue Shield ofGeorgia Customer Service Department,PO Box 7368, Columbus, GA 31908-7368.All premium checks must be made payable toBlue Cross and Blue Shield of Georgia.ABBREVIATED NOTICE OF INSURANCEINFORMATION PRACTICESPRIVACY ACTGeorgia state law establishes standards for thecollection, use and disclosure of informationgathered in connection with insurancetransactions. The application attached to thisnotice contains specific personal questionsabout you. We need your answers to decideif you qualify for coverage. We are required toadvise you that personal information may becollected from persons other than you.An investigated consumer report may bemade to help us obtain additional medicaldata from physicians or hospitals.ALL DATA CONFIDENTIALWe are required by law to keep such dataconfidential. It will be seen only by employeesand authorized agents. This data may incertain circumstances be disclosed withoutyour authorization. We may furnish suchdata to authorized federal or state agencies,consumer investigative service bureaus orothers if part of our standard businesspractice or required by law.11