Manage Your Privacy & Confidentiality

We will not disclose information to another person unless we are required or permitted to do so by law. Privacy laws prohibit us from disclosing protected health information (PHI) related to your health insurance coverage to another person or organization (with some exceptions, like your physician) without your written authorization. If you would like us to communicate with someone contacting us on your behalf (spouse, parent, child, friend, etc.), please complete the authorization release form. Our Notice of Privacy PracticesOpens a PDF describes other exceptions that may apply.

Authorization to disclose protected health information (PHI)

If you or a family member (age 18 or older, or for certain medical conditions under age 18) covered under your contract wish to designate another individual to receive information related to your health insurance and protected health information, please complete a disclosure authorization online or by using the forms below. An authorization form must be completed and returned to us for each person you or your family member wish to authorize.

Enter or update authorizations

Authorization for release of confidential HIV and related information

By completing and returning the form below (provided by the New York State Department of Health), you can authorize us to disclose your protected health information regarding HIV to another individual or organization. Privacy regulations require that this form be completed in order for us to disclose information to anyone other than you, including your parents if you are 13 years of age or older, and your spouse if you are married. There are some exceptions to the regulations. For example, your personal physician may receive this information from us without your written authorization.

Include your health insurance member ID number and your date of birth on the top of the form.

Mail or fax your completed form to the below address. Keep a copy of the completed form for your records.

Univera Healthcare
P.O. Box 221256
Eagan, MN 55121
Fax: (315) 671-7079

Obtaining your designated record set (DRS)

A designated record set (DRS) are records we maintain and use to make decisions about your healthcare coverage. You have the right to inspect and obtain a copy, or request that we amend your protected health information. Additionally, you can request an Accounting of Disclosure. The list contains instances where your PHI was disclosed for purposes other than payment, treatment, or healthcare operations.

Confidential communications and victims of domestic violence

You have the right to request to receive communications at an alternative location if disclosure of such information would endanger your safety or your child’s safety. If you would like to request confidential communications, please complete the Confidential Communications Request form below. If you have previously completed this form and wish to revoke it, please contact Customer Care at the phone number on your member card.

Additionally, per NY Insurance Law §2612, if we receive a copy of a valid order of protection against the policyholder of the policy under which you are covered, or against another person covered under the same group policy that you are, we will not, for the duration of the order, disclose to that person your address or phone number, or the address or phone number of your providers.

Victims of domestic and sexual violence can contact the NYS Domestic and Sexual Violence Hotline at 1-800-942-6906.

For more information about our privacy practices, call Customer Care at the phone number on your member card. Follow this link to file a complaint about our privacy practicesOpens a PDF.

Privacy FAQs

PHI is any information that can identify you as an individual and your past, present or future physical or mental health condition.

If not releasing the information would put your health in danger, we are permitted to release it to those who need to know it. In this case, we will not release more information than necessary.

Yes, your dependent must complete a form that will authorize us to release PHI to you.

We will need authorization from your parent to release PHI to you.

Yes. Privacy laws prohibit us from releasing information to anyone, other than the individual or provider (for payment, treatment or healthcare operations) unless there is a signed authorization on file from the individual.

A power of attorney is valid to allow us to release PHI only if it specifies that medical information can be released.

We may disclose PHI in response to a court order, subpoena, discovery request, or other lawful process.

Excellus BCBS’s authorization form only authorizes Excellus BCBS to release information to the person(s) listed. If you want to authorize your provider to speak to someone on your behalf, you will need to contact the provider directly.

There are different expiration selections you can choose on the authorization form.

We can accept a power of attorney, however, it must specifically include that you have access to your parent's medical information.

Your dependent can complete the authorization form online if they have access to the web. Or If you have a power of attorney indicating that you have access to your dependent's medical information, we will be able to release your dependent's protected health information to you.

 

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