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Electronic Communication Disclosure Form

This Electronic Communication Disclosure Form (“Disclosure”) applies to those communications, forms, disclosures and notices (“communications”) that are required to be given to you, and in some cases signed and returned to us, in connection with the insurance product(s) you have purchased from American Family Mutual Insurance Company and/or its subsidiaries. By agreeing to the terms and conditions of this Disclosure, you are agreeing to receive these communications electronically. “I”, “you” and “your” means the person or persons listed as named insureds on a policy. “We”, “us” and “Company” means the specific underwriting company identified in your quote, application and the documents we provide to you, including your insurance policy. In order to select electronic delivery of communications, you understand that you must sign up for and maintain an account through My Account on the amfam.com website. All electronic communications will be accessed through My Account on the amfam.com website.

The following information will apply if you choose electronic delivery:

  1. Your legal rights. We are required by law to provide specific communications to you in connection with the insurance product(s) you have purchased from us. You may choose to receive these communications from us electronically if we first provide you with this disclosure and obtain your consent to receive these communications electronically. Your consent will apply to all named insureds on your insurance policy(ies) that you request for electronic delivery. While we may occasionally provide some communications to you in paper form, you must agree to receive communications from us electronically and you must have the appropriate hardware and software (see #5) available to you to receive this information from us electronically.

    You acknowledge and agree that your consent to electronic communications is being provided in connection with a transaction affecting interstate commerce that is subject to the federal Electronic Signatures and National Commerce Act, and that you and we both intend that the Act apply to the fullest extent possible to validate our ability to conduct business with you by electronic means.

  2. Scope of communications to be provided in electronic form. The types of electronic communications that you are consenting to receive, acknowledge, respond to and/or sign includes, but is not limited to, the following:
    • All legal and regulatory disclosure forms, notices and communications associated with the purchase, renewal, changes and/or maintenance of your insurance policy(ies) as determined by the company and allowed by the regulatory authority.
    • All company related forms, notices and communications associated with the purchase, renewal, changes and/or maintenance of your insurance policy as determined by the company and allowed by the regulatory authority.
    • All required forms, notices and/or disclosures relating to policy limits, coverage choices, selections and rejections, including but not limited to disclosures, notices or forms related to the acknowledgement, selection or rejection of coverage.
  3. Setting your electronic communications preferences. This applies to all policies under your account that are eligible for electronic delivery. Only you will be able to set or change your preferences for electronic delivery. This preference must be made through My Account. The Company or agent will not have the ability to set or change your preferences for you. If you select electronic delivery, all policies that are eligible will be enrolled in electronic delivery. You will not be able to set your electronic delivery preferences by each individual policy.. Not all policy types may be eligible for electronic delivery.
  4. Types of communications you will receive in paper. Anything required to be sent to you in paper form as defined by your regulatory authority will be sent to you in paper copy form and may also be available electronically. In the event our electronic delivery system is unavailable, we reserve the right to provide a paper (instead of electronic) copy of any communication you have authorized us to provide electronically.
  5. Hardware and software requirements. In order to access, view, sign and retain electronic Communications that we make available to you, you must:
    • Have access to a personal computer with internet connectivity and one of the following:
      • For Windows Operating System:
      • Use IE 8.0 or higher, FireFox or Chrome with Adobe Acrobat Reader 7.0, 8.0 or 9.0
      • For Macintosh Operating System:
    • Use Safari 5.1 or higher with Adobe Acrobat Reader 8.0 or 9.0
      • Be able to view the disclosures on your monitor, which can be done with your internet browser.
      • Have a valid e-mail account with an Internet service provider in order to participate in our electronic Communications programs. It is your responsibility to provide us with a true, accurate and complete e-mail address;
      • Have sufficient electronic storage capacity on your computer’s hard drive or other data storage unit, if you want to save PDF documents;
      • A printer capable of printing a PDF document, if you need want to print documents locally from your computer.
  6. How to withdraw your consent to this e-communications disclosure.You may withdraw your consent to receive communications electronically or change your electronic delivery preferences for your policy(ies) at any time by updating your electronic delivery preferences in My Account. If you choose to withdraw your consent to receive communications electronically, all documents related to your insurance policy(ies) will be sent to you by U.S. mail. Any discounts applied to your policy(ies) that are based entirely or in part on your consent to receive communications electronically, may be removed.
  7. Requesting paper copies of communications. We will not send you a paper copy of these electronic communications, unless you request it or we otherwise deem it appropriate to do so. You can obtain a paper copy of any communication we provide to you electronically by printing it yourself or by requesting that we mail you a paper copy. Requests for paper copies must be made within a reasonable time after we first provided the electronic communication to you. To request a paper copy, contact us by telephone at 1-800-MY AMFAM (1-800-692-6326). There is no charge associated with requesting a paper copy of a communication we sent you electronically. We reserve the right to provide a paper (instead of electronic) copy of any communication that you have authorized us to provide electronically.
  8. Communications in writing. All communications in either electronic or paper format from us to you will be considered “in writing.” You should print or download for your records a copy of all electronic communications, this disclosure and any other document that is important to you. A copy of this disclosure will be available in My Account.
  9. Updating your contact information. We will provide notice of activity on your account through your e-mail. It is your responsibility to maintain current e-mail contact information in My Account. You will need to make any updates to your e-mail address where notices are sent through My Account. The Company or the agent will not be able to make e-mail contact information changes for you.

    You understand any electronic communications will be deemed as provided to you, even if you do not maintain current e-mail or contact information with us.

  10. My Account: It is your responsibility to maintain an active My Account on the amfam.com website to access policy related documents. If you disable your account, we will discontinue electronic delivery of documents and change your delivery method to paper delivery.
  11. Retain copies for your records. It is your responsibility to make any hard copies of information you want to retain for your own use. Only current documents for active policies will be available for view or print in My Account. Older documents for active and inactive policies may be archived according to reasonable document retention policies and available on request.