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Disclosure and Consent to Receive Electronic Records
Please read this document carefully, and print a copy and/or retain this information electronically for future reference.
Definitions
Agency: Blue Marsh Insurance, Inc., PO Box 333, Fleetwood, PA 19522.
Agreement: This Disclosure and Consent to Receive Electronic Records form.
Insurer: An insurance company issuing a Policy and bearing the risk.
Policy: Any and all contracts of insurance purchased through Agency between an Insurer and a customer or business entity.
Records: Any and all disclosures, declarations, contracts, Policy forms, certificates and/or documents, information, requests, applications, communications, and/or notices required by Federal Law, including, but not limited to, any adverse action notices or privacy policy notices.
You: Any individual or business purchasing insurance through the Agency.
Introduction
From time to time, the Agency may, whether on its own behalf and/or on behalf of an Insurer and/or third party, utilize the internet, e-mail, digital media or the like to transmit and/or make available via an online customer portal, Records and/or related information to policyholders. This Agreement informs You of your rights when conducting these transactions electronically. You are not required to receive Records or sign Records electronically, and may request paper copies instead.
Even if you consent to electronic delivery, the Agency may still choose to send you paper copies at your most current mailing address on file.
Hardware and Software Requirements
To access Records electronically, You need:
- An email address
- Adobe Acrobat Reader
- A device capable of accessing the internet and downloading or printing HTML or PDF files
If you are unable to access your Records electronically, contact the Agency at (610) 590-0152 or email myagent@bluemarsh.com.
If there is a material change to hardware/software requirements after consent, we will notify You and allow You to withdraw your consent without penalty.
Consent Applies to Categories of Records
Your consent applies to any and all Records, Policy documents, certificates, applications, and communications, except for cancellation or termination of health/life insurance benefits (excluding annuities). These Records will be delivered via email or customer portal.
Option to Obtain Paper Copies
To request paper copies, contact the Agency via email at myagent@bluemarsh.com or by mail at the address above. Paper copies will be provided free of charge.
Right to Withdraw Consent
You may withdraw your consent at any time by emailing myagent@bluemarsh.com or writing to the Agency. Your withdrawal will be effective within 30 days and will not affect the validity of previously delivered electronic Records.
Updating Contact Information
To update your email or mailing address, contact the Agency at (610) 590-0152 or email myagent@bluemarsh.com.
If you consent to receive electronic Records, check your email regularly to ensure timely access to documents and communications.
Consent and Acknowledgment
BY AFFIRMATIVELY RESPONDING TO THIS ELECTRONIC RECORD, YOU ACKNOWLEDGE:
- Receipt of this Agreement;
- That you can access and retain electronic Records as described;
- That you consent to receive Records electronically via email or other electronic media;
- That your Policy and related Records are considered delivered when sent electronically.