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Blue Choice

Authorization to Disclose Protected Health Information

BlueChoice HealthPlan has always had a commitment to protecting your confidential health information. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that changes the way we use and release information about you.

As of April 13, 2003, we are not allowed to give your protected health information to another person unless we have legal permission. What does this mean? If you want to let your spouse, family member or close friend contact us for your claims or payment information, we can't release it to them unless you have given us permission. You must give us your permission in writing.

For your convenience, we have created an Authorization to Disclose Protected Health Information Form. You can use this form to give us permission to release information to someone else. You don't have to complete and return this form unless you want someone other than yourself to receive your protected health information. Please note that if you're a parent of a minor child (age 15 and younger), you can still get information about your child without having to complete this form.

If you'd like to complete the form, here it is: Authorization To Disclose Protected Health Information to a Third Party.

If you'd like to learn more about how we protect your health information, please review our Privacy Practices.