ABBREVIATED NOTICE OF INSURANCE INFORMATION PRACTICES To issue an insurance policy, We need to obtain information about You and any other person proposed for insurance. Some of that information will be received from You, and some will be generated from other sources. That information and any subsequent information collected by Us may in certain circumstances be disclosed to third parties without Your specific authorization. You have the right of access and correction with respect to the information collected about You except information which relates to a claim or civil or criminal proceeding. If You wish to have a more detailed explanation of Our information practices, please contact Guardian Life Insurance Company of America, Underwriting Department, P.O. Box 659020, Sacramento, CA 95865
FRAUD NOTICE It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
The state in which the policyowner resides may have a specific state fraud warning. Please refer to the Fraud Warning Statements below.
PRIVACY We do not disclose any non-public personal information about Our customers or former customers to anyone, except as permitted by law. We collect non-public information about You from the following sources: (1) information We receive from You on application forms or other information related thereto or as part of policy administration, and (2) information about Your transactions with Our affiliates, others or Us. We restrict access to non-public personal information about You to those who need to know that information to provide products or services to You. We maintain physical, electronic and procedural safeguards that comply with federal standards to guard Your non-public personal information. We may disclose non-public personal information about You to nonaffiliated third parties as permitted by law.
Fraud Warning Statements
The laws of several states require the following statements to appear on the enrollment form:
Alabama: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof.
Arizona: For your protection Arizona law requires the following statement to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties.
California: The falsity of any statement in the application for any policy covered by this chapter shall not bar the right to recovery under the policy unless such false statement was made with actual intent to deceive or unless it materially affected either the acceptance of the risk or the hazard assumed by the insurer.
Colorado: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.
Connecticut, Iowa, Nebraska, and Oregon: Any person who knowingly, and with intent to defraud any insurance company or other person, files an application of insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, may be guilty of a fraudulent insurance act, which may be a crime, and may also be subject to civil penalties.
Delaware, Indiana and Oklahoma: WARNING: Any person who knowingly, and with the intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.
District of Columbia: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant.
Florida: Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
Kansas: Any person who knowingly, and with intent to defraud any insurance company or other person, files an application of insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto, may be guilty of insurance fraud as determined by a court of law.
Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.
Louisiana and Texas: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit is guilty of a crime and may be subject to fines and confinements in state prison.
New Mexico: Any person who knowingly presents a false or fraudulent claim for payment or a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties or denial of insurance benefits.
Maine, Tennessee, and Washington: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefit.
Maryland: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
Minnesota: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.
New Hampshire: Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud, as provided in N.H. Rev. Stat. Ann. § 638:20.
New Jersey: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties.
Ohio: Any person who with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.
Pennsylvania: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
Rhode Island: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
Vermont: Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law.
Virginia: Any person, who with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement may have violated state law.
Legal Notices and Disclaimers
Terms and Conditions of The Guardian Life Insurance Company of America ("Guardian") Direct to Consumer “My Dental” website (www.mydental.guardianlife.com, also referred to herein as “the Website”)
Your accessing and use of this Website, indicate your agreement to the Terms contained below and any modifications of these Terms made by Guardian, and constitute your representation that you have reviewed and agreed to all such Terms as well as the Privacy Policy to which a link is provided below, and that you are at least 18 years old.If you do not agree to the Terms below, you are not authorized to use the Website and you should leave this Website immediately.
You are responsible for reviewing the Terms periodically for revisions to these Terms. If any revisions are unacceptable to you, you should discontinue using the Website. Your continued use of the Website following the posting of any such revisions will indicate your acceptance of the revised Terms.
Guardian makes every effort to ensure the accuracy of information provided, however information listed is not guaranteed to be accurate or up-to-date and may be subject to change without notice. For the most up-to-date information, please call the number listed under the following links depending on whether you purchased directly from the Website or through the exchange.
Guardian is the owner or licensee of all rights in the Website, its content, software, and services. The Website is provided for personal, non-commercial use only. You have no right to reproduce disseminate the Website content or software in whole or in part, or make any other use of the Website content, software or services if not expressly granted in these Terms. "The Guardian Life Insurance Company of America," "Guardian," the G Guardian Logo and other marks of Guardian and its subsidiaries, as well as marks of Guardian's licensors and providers, are proprietary to Guardian or its licensors and providers. No right, title or interest in those trademarks is granted to you in these Terms, and you are not authorized to reproduce or otherwise use any such trademarks absent prior express written approval from Guardian or the applicable licensor or provider.
SERVICES PROVIDED THROUGH AND INFORMATION CONTAINED THROUGH THE GUARDIAN DIRECT TO CONSUMER “MY DENTAL” WEBSITE ARE PROVIDED AS IS AND AS AVAILABLE. GUARDIAN MAKES NO, AND HEREBY DISCLAIMS ANY, WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF TITLE, NONINFRINGEMENT, MERCHANTABILITY AND FITNESS FOR A PARTICULAR USE OR PURPOSE. FURTHER, GUARDIAN DISCLAIMS ANY WARRANTY THAT THE SITE WILL BE AVAILABLE AT ALL TIMES, WILL OPERATE WITHOUT INTERRUPTION OR ERROR, OR WILL BE SECURE AND FREE OF TECHNOLOGICAL DIFFICULTIES INCLUDING, BUT NOT LIMITED TO, UNAVAILABILITY OF INFORMATION, DOWNTIME, SERVICE DISRUPTIONS, COOKIES, VIRUSES, WORMS, "TROJAN HORSES", HACKING, OR OTHER HARMFUL OR DESTRUCTIVE ELEMENTS. GUARDIAN MAKES NO WARRANTY AS TO THE RELIABILITY, ACCURACY, TIMELINESS, USEFULNESS, ADEQUACY, COMPLETENESS OR SUITABILITY OF THE SERVICES OR INFORMATION PROVIDED THROUGH THE WEBSITE.
YOU AGREE TO BE SOLELY RESPONSIBLE FOR YOUR USE OF THE WEBSITE. GUARDIAN, ITS OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, AND INFORMATION PROVIDERS SHALL NOT BE LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, OR PUNITIVE DAMAGES ARISING OUT OF YOUR USE OF OR INABILITY TO USE THE WEBSITE EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
THESE LIMITATIONS SHALL APPLY WHETHER THE ASSERTED LIABILITY OR DAMAGES ARE BASED IN CONTRACT (INCLUDING, BUT NOT LIMITED TO, BREACH OF WARRANTY), TORT (INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE) OR ANY OTHER LEGAL OR EQUITABLE GROUNDS. YOUR SOLE AND EXCLUSIVE REMEDY FOR DISSATISFACTION WITH THE WEBSITE IS TO STOP USING THE WEBSITE.
ELECTRONIC COMMUNICATION IS NOT APPROPRIATE FOR ALL HEALTH ISSUES, PARTICULARLY THOSE OF AN URGENT NATURE AND GUARDIAN MAKES NO GUARANTEE OF ANY PARTICULAR RESPONSE TIME TO ANY INQUIRY YOU MAY MAKE. ACCORDINGLY, IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, YOU SHOULD NOT USE THIS SITE FOR ASSISTANCE, BUT SHOULD INSTEAD SEEK APPROPRIATE EMERGENCY MEDICAL ASSISTANCE.
The Website may contain links to other Web sites, and other Web sites may provide links to this site. These links are provided for your convenience only. You should not consider any link to or from another site as an endorsement of that site by Guardian unless Guardian expressly states so. Guardian does not control and is not affiliated with these other sites or their owners, and assumes no liability or responsibility for such sites, including the functionality or security of any such sites or the accuracy of any content or services provided to you by such sites. Guardian does not guarantee or warrant that use of the Website or any linked site will be secure or free from technological difficulties including, but not limited to, unavailability of information, downtime, service disruptions, cookies, viruses, worms, "Trojan horses", hacking, or other harmful or destructive elements. You understand that you are responsible for implementing sufficient procedures and checkpoints to satisfy your particular requirements for safety and accuracy of data input and output.
You agree that, should you elect to supply it, Guardian may use your e-mail address, to communicate with you. Guardian uses this information consistent with Guardian's Privacy Policy.
Guardian may use tracking technologies which automatically record and store information about you and your visit to this Website and/or your use of the Website, including: the internet domain and IP address from which you access the Website; the type of browser software and operating system used to access the Website; the date and time you access the Website; the pages from which you enter, visit and exit the Website, and if you linked to the Website from another site, the address of that Website; and your user identity if you are logged in.
This tracking may be done by using a "cookie" which would be stored on your browser. If you do not wish to allow such cookies: you can configure most Internet browsers to refuse to allow new cookies, to prompt you before accepting new cookies, or to disables cookies altogether. Exactly how this is done is dependent on the browser you use. For more information on cookies, please visit http://www.allaboutcookies.org/
Guardian may use such information to help us identify click stream patterns, to improve the Website and application, and to learn about the number of visitors to the Website and the types of technology our visitors use, to ensure that the Website and application remain compatible with a selection of browsers and systems and are benefitting users.
These Terms together with Guardian's Privacy Policy constitute the entire and only understanding between you and Guardian regarding your use of the Website. No modification or attempted modification of these Terms by you shall be binding on Guardian unless made in writing and physically signed by an authorized representative of Guardian. Guardian may modify these Terms at any time and such modifications shall be effective immediately upon posting the modified terms and conditions on this site. The Website is provided by Guardian as a courtesy to you, and Guardian reserves the right to modify, suspend or discontinue this site, or any part thereof, at any time, with or without notice. In addition, your access to the Website may be discontinued at any time if you violate the terms of this Agreement or if Guardian in its sole discretion determines, for any other reason, that it is no longer appropriate for you to have access to the Website.
Notices sent to you by Guardian in connection with these Terms or your use of the Website may be delivered to you by electronic mail, a general notice on the Website, or by any other legally permissible method.
Failure by Guardian to enforce any provision of these Terms shall not be deemed a waiver of such provisions.
This application form, recorded Authorizations and any amendments shall be the basis for the policy.
The insurance, if approved by Guardian Life Insurance Company of America(Guardian), will be in force only when issued by Guardian Life Insurance Company of America. The premium must be paid when due. A change in my eligibility or the proposed dependent(s) after the completion of the application form and before the delivery of the contract may affect my eligibility for insurance with the company. I understand and agree that any information I provide through this application form process may be shared with persons necessary to facilitate issuing coverage, including but not limited to my agent or broker. I understand that I have a right to receive a copy of this authorization.
I understand that this authorization is required in order to enable Guardian Life Insurance Company of America to make eligibility or application determinations relating to me and/or my dependent(s). If I refuse to sign or revoke this authorization, Guardian Life Insurance Company of America may refuse to consider this application for insurance. I understand that I may revoke this authorization at any time by notifying Guardian Life Insurance Company of America in writing of my desire to revoke. Such revocation must be sent by certified mail to the following address: P.O. Box 659020, Sacramento, CA 95865. Such revocation will not be valid if Guardian Life Insurance Company of America has taken action in reliance on the authorization. Unless an earlier date is required by law, this authorization expires upon the earliest of the following events: 30 days after denial of this application, or if insured, 30 days after no longer being insured by Guardian Life Insurance Company of America. But in no event will this authorization be in effect for longer than 24 months from the date signed.
I agree that a photocopy of this authorization shall be valid for two years from the date signed.
I acknowledge receiving the notification regarding the Abbreviated Notice of Insurance Information Practices and the Outline of Coverage for dental Insurance, if required.
I acknowledge that I have read the completed application form. I attest that all statements and answers on this application form are complete, true and correct. I understand and acknowledge that any fraudulent statement or material misrepresentation or omission on the application form, recorded Authorizations and/or any amendments may result in claim denial or contract rescission, subject to the Incontestability provision of the policy.
I acknowledge and consent to receiving electronic copies of applicable insurance related document, in lieu of paper copies, to the extent permitted by applicable law. I may change this election only by providing 30 days prior written notice.
You are not required to conduct business electronically. However, this disclosure is to obtain your consent to proceed applying for Guardian products and services online. By providing your consent in the manner set forth below and clicking the "Proceed to Payment" button at the bottom of the Page, you will be able to apply for Guardian products and services online.
Your consent is being sought by Guardian. Guardian makes these disclosures to you prior to asking you to consent to the use of an electronic record to provide or make available information to you. This disclosure and consent conforms to the provisions of the U.S. Electronic Signatures in Global and National Commerce Act ("E-SIGN"), codified at 15
U.S.C. Section 7001 et seq.
1. Summary of Your Consent. At the bottom of the Fraud Warning page on the mydental.guardianlife.com website, after you have reviewed these disclosures, you will be asked to give your consent (your "Consent") to Guardian's use of an electronic record rather than paper format to provide or make available to you the following information (the "Information") via any Guardian website or by e-mail (collectively "Electronic Record(s)"), subject to the conditions and other requirements discussed below:
1. Information contained in (or visibly referenced by a lin<B>k contained in) the website location you are now reading; and
2. Information related to your online application for a Guardian product or service; and
3. Information contained in any and all e-mail messages constituting legal notices or other communications related to Guardian products or services (including without limitation, changes by Guardian to the procedure for online enrollment set forth in this website) sent to you in the future by Guardian or its representatives during the course of your relationship with Guardian (the "E-Mail Messages"), addressed with the Internet e-mail address you supply to Guardian in the "Personal Information" section of the Mydental.guardianlife.com website; and
4. Information in any Guardian website location that is visibly referenced by a link contained in E-Mail Messages.
2. Hardware and Software Requirements. As of the date you are reading this paragraph, your hardware and software requirements for access to and retention of the Electronic Records are the following, at a minimum:
Website browser at least equivalent to Microsoft Internet Explorer 11.x, Google Chrome 46 and above and equipped with SSL security of no less than 128 bits;
1. Internet e-mail software reasonably capable of sending and receiving Internet e-mail messages to and from Guardian, as demonstrated in the method required provided below as part of the Consent, together with authorized access to an e-mail account with reasonable inbox and outbox message storage, and the ability to access information in website locations visibly referenced by a link in an e-mail message; and
2. Computer or other device (together with appropriate operating system and application software), that is capable of accessing the public Internet using a modem or other interfacing hardware that provides connectivity to an Internet Service Provider via ordinary telephone lines, cable television, DSL, T1 or any other communications medium, or using a direct networked connection, and is reasonably capable of (i) storing Electronic Records in electronic format and accessing such stored Electronic Records, or (ii) printing Electronic Records on paper or converting Electronic Records to another medium that provides reasonable retention and access.
3. Change in Hardware and Software Requirements. After you have given your Consent, if Guardian changes the hardware or software requirements needed for you to access or retain Electronic Records, and this change creates a material risk that you will not be able to access or retain a subsequent Electronic Record, Guardian agrees to provide you with a revised statement of the hardware and software requirements for access to and retention of the Electronic Records. You agree to provide Guardian with your Internet email address, keeping it current by updating the Internet email address on record in Mydental.guardianlife.com in the section labeled "Personal Information".
4. Withdrawal of Consent. After you have given your Consent, you may withdraw your Consent to Guardian's use of Electronic Records by contacting the Customer Service department through the following Privacy Policy link. Withdrawal of Consent will immediately remove your access to the product or service you signed up for initially. You will have to complete the process again to re-instate your use of the service.
5. Requesting a Paper Copy; Handling Fees. After you have given your Consent, if you desire any paper copies in addition to those you may choose to prepare yourself by downloading and printing out a copy of Electronic Records, you have the right or option to have provided or made available to you a paper copy of any Electronic Record relating to your use of Mydental.guardianlife.com services. You may exercise this right or option, by contacting our Customer Response Unit phone number listed on your insurance card. Guardian does not intend to charge a fee for this service. We do, however, reserve the right to do so in the future and will provide 30 days advance notice to all users through the system.
In accordance with the foregoing paragraphs of Disclosures to you by Guardian, if you desire to give your Consent to the use of Electronic Records to provide or make available the Information described in paragraph 1 above, click on the "Proceed to Payment" button. If you click on that button, your Consent to such use of Electronic Records will be sent to Guardian via the Mydental.guardianlife.com website. The receipt of your Consent by Guardian will serve to demonstrate that you can access Information in electronic form provided or made available to you by the Mydental.guardianlife.com website.
Upon receipt of such Consent, Guardian will continue with the application process you requested by following Internet links to access this application.
