HIPAA Notice of Privacy Practices (NoPP) and Privacy Forms
NoPP
The NoPP is a separate document from the website Privacy Statement. It is a notice that Blue Cross and Blue Shield of Illinois (BCBSIL) is required by the Health Insurance Portability and Accountability Act (HIPAA) to provide to members covered under a BCBSIL insurance policy. The notice describes the way in which BCBSIL can use or disclose the Protected Health Information (PHI) that we maintain about you. Members of a self-funded plan should obtain a notice from their employer/group health plan.
Privacy Forms
Under HIPAA, you have several rights related to your privacy. For example, you can:
- Provide authorization for BCBSIL to share your PHI
- Request access to your PHI
- File a complaint
To make a request, please print out and complete the appropriate form below, sign the form and mail it according to the instructions provided.
Standard Authorization Form with Instructions (with fill-in fields) 
Standard Authorization Form with Instructions 
Request for Accounting of PHI Disclosures
Confidential Communications Request
Privacy Questions or Concerns
If you have any questions or concerns about your privacy rights, call the number on the back of your membership card or call us at 877-361-7594. You may also write us at:
Privacy Office
P.O. Box 804836
Chicago, IL 60680-4110
V12.18.2012
