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167.164.4.31  Public Scan

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Submitted URL: http://www.highmarkblueshield.net/
Effective URL: https://www.highmarkblueshield.com/gdpr/index.html
Submission: On February 16 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

<form id="consent-form">
  <div class="form-inputs-wrapper">
    <span class="form-required">* Required Fields</span>
    <span>*</span>First name <input class="validate" onkeyup="validateName(this)" name="firstname" maxlength="25" type="text" required=""> <br> Middle Name (optional) <input onkeyup="validateName(this)" name="middlename" maxlength="25"
      type="text"><br>
    <span>*</span>Last Name <input class="validate" onkeyup="validateName(this)" name="lastname" maxlength="35" type="text" required=""> <br> Suffix (optional) <input onkeyup="validateName(this)" name="suffix" maxlength="10" type="text"> <br>
    <span>*</span>Email Address <input class="validate" onkeyup="validateEmail(this)" name="email" maxlength="255" type="email" required=""> <br> Date<br>
    <p id="currentDate" style="font-size: 17px;font-weight: 500;">16,Feb 2024</p><br>
    <input type="checkbox" name="consent" required=""><span>*</span> I agree to Consent <br>
  </div>
  <div class="btn-wrapper">
    <button type="reset" form="consent-form" value="Reset">Cancel</button>
    <button id="submit-consent-form" type="submit" form="consent-form" value="Submit">Submit</button>
  </div>
</form>

Text Content

HIGHMARK HEALTH DATA PROTECTION STATEMENT AND INFORMED CONSENT FOR EU DATA
SUBJECTS

--------------------------------------------------------------------------------

The purpose of this Data Protection Statement is to notify you of the practices
that will govern the processing of your personal data and to obtain your
explicit consent for the processing of your personal data consistent with it, in
particular in accordance with the legal requirements of the European Union’s
(“EU”) General Data Protection Regulation (“GDPR”):

The personal data collected may include your address, city, postal code,
country, phone number, email address, IP address, as well as any other personal
information you choose to provide (“Personal Data”). This information will be
used for purposes of performing services to, or on behalf of, our enterprise
customers and prospective customers as part of and in relation to matters
regarding our provider, health plan, and subsidiary enterprise care delivery,
administration and operations. We will retain the information in our system in
accordance with applicable law and our Data Protection
Policy:https://www.highmark.com/hmk2/gdpr.shtml

Your email address and phone number may be used to contact you. All reasonably
appropriate measures will be taken to prevent disclosure of your Personal Data
beyond the scope provided directly or indirectly herein or as may be reasonably
inferred from the content contained in this notice or the website.

Your Personal Data will be disclosed to appropriate personnel for purposes of
performing services to, or on behalf of, our enterprise customers and
prospective customers as part of and in relation to matters regarding our
provider, health plan, and subsidiary enterprise care delivery, administration
and operations. Notwithstanding the above disclosures, we will disclose the
Personal Data we collect from you under the following circumstances:

 * (i) when required or permitted by law or government agencies,
 * (ii) when required valid requests by law enforcement,
 * (iii) for purposes relevant to corporate policies or litigation to the extent
   permitted under applicable law or when it is prescribed in GDPR or other
   applicable law.

We use third-party service providers to process Personal Data, including,
without limitation, for information storage and other similar purposes. These
services providers are located in the United States. These service providers
will be bound by sufficient guarantees to implement appropriate technical and
organizational measures in such a matter that their processing will meet the
requirements of applicable law.

Your Personal Data will remain on file for: any period required by applicable
law; and, to the extent necessary for any purpose(s) provided directly or
indirectly herein or as may be reasonably inferred from the content contained in
this notice or the website, but no longer than permitted by applicable law.
After that, all Personal Data will be deleted or the documents with such data
will be anonymized. If you have questions regarding how we process your Personal
Data and what we store about you, please contact
PrivacyInternational@HighmarkHealth.org or write us:

Data Protection Officer Highmark Health 120 Fifth Avenue, Suite 2114 Pittsburgh,
PA 15222, USA


CONSENT

By agreeing to the terms and conditions set out in this Data Protection
Statement, and by providing us with your Personal Data, you consent to the
collection, use and disclosure of any information you provide in accordance with
the above purposes and this Data Protection Statement.

You also explicitly consent to the automated decision making by us, which may
include the processing of your health data, to the extent that it is necessary
to process your health claim swiftly and efficiently.

Notes: This consent is given voluntarily and can be revoked at any time in
writing by sending an email to PrivacyInternational@HighmarkHealth.org If you
want to exert your withdrawal right or your rights to access, rectify, block,
transfer or delete your personal data pursuant to the GDPR, please contact us
and provide us at least with your full name, address and the data processing you
are inquiring about. If you are not satisfied with our data processing you have
the right to lodge a complaint to the data protection authority in your country
of residence.

* Required Fields *First name
Middle Name (optional)
*Last Name
Suffix (optional)
*Email Address
Date


16,Feb 2024


* I agree to Consent

Cancel Submit