PRIVACY PRACTICES NOTICE AND FORMS

Privacy Practices Notice

Blue Cross and Blue Shield of Texas (BCBSTX) is required by federal and state law to give a notice to plan members about how we can use and disclose their personal health and financial information. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) helps to protect your privacy. If you are covered by a health insurance plan, you should get a Privacy Practices Notice. The notice tells how your Protected Health Information (PHI) can be used or disclosed.

• View the BCBSTX Privacy Practices Notice
  (This notice is different than the website Privacy Statement.)

Privacy Forms

As described in the Privacy Practices Notice, you have certain rights related to your privacy. In order to exercise one of these rights, please print out a form from the list below. Once you complete the form, sign and mail it to the address shown on that form. You can also call the number on the back of your member ID card to ask for a copy of the form you want.

• Standard Authorization Form with Instructions
• Request to Access PHI
• Request to Amend PHI
• Request for Accounting of PHI Disclosures
• Response to Denied Amendment
• Confidential Communications Request
• Restriction Request
• Privacy and Security Complaint

Privacy Questions or Concerns

Do you have any questions or concerns about your privacy rights? Call the number on the back of your member ID card, or call us at 877-361-7594. You may also write to:

Privacy Office
P.O. Box 804836
Chicago, IL 60680-4110

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