# Mass. Gen. Laws ch. 175I, sec. 6: Disclosure authorization form; contents > Massachusetts · Statutes · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S6 ## Section - **Citation:** Mass. Gen. Laws ch. 175I, sec. 6 - **Heading:** Disclosure authorization form; contents - **Jurisdiction:** Massachusetts - **Kind:** Statutes - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** MA Code / Part I / Title XXII / Chapter 175I / Section 6 ## Text Section 6. Notwithstanding any general or special law to the contrary, no insurance institution, insurance representative or insurance-support organization may utilize as its disclosure authorization form in connection with insurance transactions a form or statement which authorizes the disclosure of personal or privileged information about an individual to the insurance institution, insurance representative or insurance-support organization unless the form or statement: (1) is written in plain language; (2) is dated; (3) specifies the types of persons authorized to disclose information about the individual; (4) specifies the nature of the information authorized to be disclosed; (5) names the insurance institution or insurance representative and identifies by generic reference the representative of the insurance institution to whom the individual is authorizing information to be disclosed; (6) specifies the purposes for which the information is collected; (7) specifies the length of time such authorization shall remain valid, which shall be no longer than: (A) in the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement or a request for change in policy benefits, thirty months from the date the authorization is signed; or (B) in the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy: (i) the term of coverage of the policy if the claim is for a health insurance benefit; or (ii) the duration of the claim if the claim is not for a health insurance benefit; and (8) advises the individual or a person authorized to act on behalf of such individual that such individual or the individual's authorized representative is entitled to receive a copy of the authorization form. Section 6. Notwithstanding any general or special law to the contrary, no insurance institution, insurance representative or insurance-support organization may utilize as its disclosure authorization form in connection with insurance transactions a form or statement which authorizes the disclosure of personal or privileged information about an individual to the insurance institution, insurance representative or insurance-support organization unless the form or statement: (1) is written in plain language; (2) is dated; (3) specifies the types of persons authorized to disclose information about the individual; (4) specifies the nature of the information authorized to be disclosed; (5) names the insurance institution or insurance representative and identifies by generic reference the representative of the insurance institution to whom the individual is authorizing information to be disclosed; (6) specifies the purposes for which the information is collected; (7) specifies the length of time such authorization shall remain valid, which shall be no longer than: (A) in the case of authorizations signed for the purpose of collecting information in connection with an application for an insurance policy, a policy reinstatement or a request for change in policy benefits, thirty months from the date the authorization is signed; or (B) in the case of authorizations signed for the purpose of collecting information in connection with a claim for benefits under an insurance policy: (i) the term of coverage of the policy if the claim is for a health insurance benefit; or (ii) the duration of the claim if the claim is not for a health insurance benefit; and (8) advises the individual or a person authorized to act on behalf of such individual that such individual or the individual's authorized representative is entitled to receive a copy of the authorization form. ## Nearby sections - [Mass. Gen. Laws ch. 175I, sec. 1 Application of chapter](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S1.md) - [Mass. Gen. Laws ch. 175I, sec. 2 Definitions](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S2.md) - [Mass. Gen. Laws ch. 175I, sec. 3 Pretext interviews; use](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S3.md) - [Mass. Gen. Laws ch. 175I, sec. 4 Notice of information practices; time; contents; abbreviated notice](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S4.md) - [Mass. Gen. Laws ch. 175I, sec. 5 Questions to obtain marketing or research information; disclosure](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S5.md) - [Mass. Gen. Laws ch. 175I, sec. 6 Disclosure authorization form; contents](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S6.md) - [Mass. Gen. Laws ch. 175I, sec. 7 Investigative consumer report; personal interview; prohibited information](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S7.md) - [Mass. Gen. Laws ch. 175I, sec. 8 Recorded personal information; medical record information; disclosure; fees](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S8.md) - [Mass. Gen. Laws ch. 175I, sec. 9 Correction, amendment or deletion of personal information](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S9.md) - [Mass. Gen. Laws ch. 175I, sec. 10 Adverse underwriting decision; notice; reasons; disclosure of medical or mental health record information; summary of rights](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S10.md) - [Mass. Gen. Laws ch. 175I, sec. 11 Prior adverse underwriting decisions; requests for information by insurance organizations](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S11.md) - [Mass. Gen. Laws ch. 175I, sec. 12 Adverse underwriting decision; basis](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S12.md) - [Mass. Gen. Laws ch. 175I, sec. 13 Personal or privileged information from insurance transactions; disclosure](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S13.md) - [Mass. Gen. Laws ch. 175I, sec. 14 Investigations](https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S14.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_MA_PI_TXXII_C175I_S6. Check the current official text before relying on it. Not legal advice.