HIPAA Privacy Forms for Employers and Members
Below are the current communications/forms regarding Member HIPAA privacy that are available to view and/or download*, including our Notice of Privacy Practices. This Notice describes how we use and share member information and outlines individual privacy rights.
If you have any questions about this information, please call 800.962.2242.
- HIPAA Privacy Notice
- Group Certification Form
- Group Health Plan Representatives Authorized to Receive Member Information Form
- Member Authorization Form
- Appeals Authorization Form for Traditional/Indemnity Lines of Business