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HIPAA Privacy Notices & Forms
For Policyholders
We are required by the privacy regulations issued under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") to maintain the privacy of our customers' Personal Health Information and to provide customers with notice of our legal duties and privacy practices with respect to their Personal Health Information.
HIPAA Privacy Notice
These forms are used to communicate with us on how your Personal Health Information can be used.
Authorization To Use and Disclose Personal Information
Representative Authorization To Use and Disclose Personal Information
Member Request To Restrict Uses and Disclosures of Personal Health Information
Confidential Communication Request
Privacy Complaint Form
Access Request Form
Amendment Request Form
Disclosure Accounting Request Form
For Agents
Business Associate Agreement
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HIPAA Privacy Notices & Forms
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