My DKV

Explicit consent for the transfer of your medical claims statements to your insurance intermediary(ies)

Your personal data (including your health data which include your medical claims statements) are processed by DKV Belgium NV ("DKV"), a company incorporated and existing under Belgian law, having its registered office at 25, Rue de Loxum, 1000 Brussels, Belgium, registered with the Crossroads Bank for Enterprises under company number 0414.858.607, tel: +32(0)22876411.
DKV attaches great importance to your privacy and processes your personal data (including your health data) in accordance with the General Data Protection Regulation (EU) 2016/679 (the "GDPR") and any national legislation adopted pursuant to the GDPR. DKV will process your personal data (including your health data) in the capacity of data controller. More information about the processing of your personal data (including your health data) by DKV can be found in the DKV Privacy Statement. The latest version of this statement can always be found at www.dkv.be/privacy.
If you give your explicit consent thereto, your insurance intermediary/intermediaries receive(s) only an electronic access to your medical claims statements (no other health data) established in the context of your individual contract(s).If you do not give your consent, these medical claims statements will thus not be transferred to your insurance intermediary/intermediaries.
This consent applies only to all your medical claims statements, both those made prior to giving your consent and those that follow.
If different insurance intermediaries intervene for different individual insurance contracts which you have with DKV, you consent to transfer your medical claims statements to each of these insurance intermediaries. However, your medical claims statements will only be transferred to insurance intermediaries intervening for the individual insurance contract to which these claims statements relate. To insurance intermediaries who are not intervening for the individual insurance contract to which your claims statements relate, these claims statements will not be transferred. *
You understand and accept that when DKV transfers your medical claims statements to your insurance intermediary/intermediaries, DKV can no longer be held responsible for what your insurance intermediary/intermediaries do(es) with your medical claims statements. Indeed, your insurance intermediary/intermediaries will process your medical claims statements for his own purposes and will act as controller independent of DKV.
DKV can therefore not be held liable for damage caused by your insurance intermediary/intermediaries when processing your medical claims statements after they have been transferred by DKV.
You have the right to withdraw your consent at any time via your personal My DKV portal. When you withdraw your consent, the electronic access to your claims statements is stopped, and thus none of your former nor future medical claims statements will still be transferred to your insurance intermediary/intermediaries. However, the transfer of your medical claims statements prior to the withdrawal of consent remains legitimate, i.e. your consent remains valid for each transfer carried out by DKV prior to the withdrawal of your consent.
If you wish to exercise your rights or have questions, comments, requests, complaints about this consent or the processing of your personal data (including health data) by DKV, please contact the Data Protection Officer of DKV by post at Loksumstraat 25 Rue de Loxum, 1000 Brussels, Belgium or by e-mail at privacy@dkv.be.

Yes, I hereby give my explicit consent to DKV to transfer my medical claims statements to my insurance intermediary/intermediaries as described above. If these medical claims statements relate to a minor (under the age of 18), I give this consent in my capacity as holder of parental responsibility over the child.

* Title 5 is not applicable to any collective or group insurance subscribed by your employer at DKV to which you are affiliated.

Consent Date

First Name

Surname

Birth date

Of age?

Yes No

Name of the legal representative

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