Privacy Practices Notice and Forms
Privacy Practices Notice
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) helps to protect your privacy. If you are covered by a health plan, you should get a Privacy Practices Notice.
Blue Cross and Blue Shield of Illinois (BCBSIL) is required by federal and state law to give a Privacy Practices Notice to plan members. The notice explains how BCBSIL can use and share a member’s health and financial information.
(This notice is different than the website Privacy Statement.)
Privacy Forms
You have certain rights related to your privacy. To make a request regarding these rights, use a privacy form. You can:
- Print out a form. Complete and sign the form, then mail it to the address shown on the form.
- Request to have a certain form sent to you. Call the Member Services number shown on your member ID card.
Use this form to ask BCBSIL to share your protected health information (PHI) with a certain person or entity.
Use this form to ask BCBSIL for a copy of your PHI records.
Use this form to ask BCBSIL to update your PHI.
Use this form to get a record of how BCBSIL shared your PHI.
If you had a request to update your PHI denied by BCBSIL, use this form. You can ask that the original request and the denial be attached to future disclosures of your PHI.
Do you feel your life could be in danger if you get mail at your current address? Use this form to ask BCBSIL to restrict your PHI and communicate with you at an alternate location.
Use this form to ask BCBSIL to restrict your PHI from being used or shared with another person or non-covered entity under HIPAA.
Use this form to file a privacy or security complaint with BCBSIL.
Privacy Questions or Concerns
Do you have any questions or concerns about your privacy rights?
- Call: Use the number on the back of your member ID card. Or you can call 1-877-361-7594.
Write to:
Privacy Office
Blue Cross and Blue Shield of Illinois
300 East Randolph Street
Chicago, IL 60601-5099
1.0-2024