Privacy Practices Notice and Forms
Privacy Practices Notice
Boeing is required by federal and state law to provide their plan members with a notice about how personal health and financial information can be used and disclosed.
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 customer service number listed on your member ID card to ask for a copy of the form you want.
• Standard Authorization Form with Instructions
• Request for Accounting of PHI Disclosures
• Response to Denied Amendment
Privacy Questions or Concerns
Do you have questions or concerns about your privacy rights? Call the customer service number listed on your member ID card, or call us at 1-877-361-7594. You may also write to:
Privacy Office
Blue Cross and Blue Shield of Illinois
P.O. Box 804836
Chicago, IL 60680-4110