Privacy

HIPAA Privacy Information

Commitment to protecting the privacy of our members’ personal health information is of the highest importance to us, as is compliance with the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires us to take additional measures to protect personal information and to inform our members about those measures. The following documents have been developed for you.

Download the most current version of Adobe Acrobat Reader for free:

HIPAA Privacy Documents

Review the Notice of Privacy Practices (PDF) to learn how your personal health information may be used and disclosed, and how you can have access to this information.

HIPAA Privacy Forms

MedicareBlue PPO members may use these forms:

Authorization to Release Information (PDF) -- to authorize your health plan to release health information
Personal Representative Form (PDF) -- to appoint another person as your personal representative

MedicareBlue Rx members may use these forms:

Authorization to Release Information (PDF) -- to authorize your health plan to release health information
Instruction Sheet for Authorization to Release Information (PDF)
Personal Representative Form (PDF) -- to appoint another person as your personal representative

May 16, 2008

Important Information

This page last updated and accepted by CMS January 2008.

MedicareBlue PPO and MedicareBlue Rx coverage is provided by only one of the following plans, depending on the state in which the policy is issued: Wellmark Blue Cross and Blue Shield of Iowa,* Blue Cross and Blue Shield of Minnesota,* Blue Cross and Blue Shield of Montana,* Blue Cross and Blue Shield of Nebraska,* Blue Cross Blue Shield of North Dakota,* Wellmark Blue Cross and Blue Shield of South Dakota,* and Blue Cross Blue Shield of Wyoming.*

*Independent licensees of the Blue Cross and Blue Shield Association.

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