HIPAA Privacy Information and Forms

The privacy and security of your health information is very important to The Health Plan. For that reason, we have procedures in place to ensure that your information is well protected. The following notice describes how your medical information may be used and disclosed and how you can get access to this information.

• Notice of Privacy Practices 

Our Customer Service Department is available to assist you with any questions or concerns.
You can call them at 1.800.624.6961 (TTY: 711).

In addition, you have rights under HIPAA.  To exercise these rights, we have provided the following forms:

• Request to Amend Protected Health Information
  Use this form to ask us to correct your health and claims records.
• Request for an Accounting of Disclosures 
  Use this form to get a list of those which whom we have shared your information.
• Privacy Complaint
  Use this form to submit a complaint if you feel we have violated your privacy rights.
• Individual Request for Access to Protected Health Information
  Use this form to get a copy of your health and claims records.
• Authorization to Disclose Protected Health Information
• Use this form to give us permission to share your information with someone else.
• Request for Restriction on Uses/Disclosures of PHI
  Use this form to ask us to limit the health information that we use or share about you.
• Confidential Communications for Protected Health Information
  Use this form to ask us to contact you in a specific way or to send mail to a different address.