Illinois Insurance Law section 215 ILCS 5/355b and Insurance Regulation 50 Ill. Adm. Code 2028
We will accommodate a reasonable request made by a person to receive communications of claim related information by alternative means or at alternative locations if the person clearly states in writing that disclosure of all or part of the information could endanger the person. If a child is covered by us, then the child's parent or guardian may make such a request.
Upon receipt of a written request or valid protective order, we will not disclose the following information to a policyholder, except with your consent: (1) the address, telephone number, or any other personally identifying information of the individual who made the request or child for whose benefit a request was made; (2) the nature of the health care services provided; or (3) the name or address of the provider of the health care services.
Making a Request
To make a request, please complete this form and submit it to the following address:
Standard Insurance Company
Legal and Compliance Department
900 SW Fifth Ave.
Portland, OR 97204
Revoking a Request
A person may revoke this request by notifying us in writing. For identity verification, the person will be asked to provide us with the alternate address that was initially disclosed to us.
State of Illinois Domestic Violence Helpline
For further information on domestic violence services in the state of Illinois, a person may contact the State of Illinois Domestic Violence Victim Services Helpline. The contact information for the helpline is listed below. A person may also access State of Illinois Domestic Violence Victim Services website.
State of Illinois Department of Human Services, Domestic Violence Victim Services:
- 1-877-TO END DV or 1-877-863-6338 (Voice)
- 1-877-863-6339 (TTY)
The hotline is toll free, confidential, multilingual and open 24-hours.