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Privacy - Contact Us
Privacy - Contact Us

If you are concerned that your privacy rights have been violated, you may let us know by calling the number on the back of your member identification (ID) card. If you do not have an ID card and have a privacy concern you can reach us by calling 877-361-7594.

Written communications can be sent to:

Director, Privacy Office
P.O. Box 804836
Chicago, IL 60680-4110
Privacy Forms
Standard Authorization Form (Microsoft Word)
Standard Authorization Form (Adobe pdf)
Instructions for Completing the Standard Authorization Form (Microsoft Word)
Access Request (Adobe pdf)
Disclosure Accounting Request (Adobe pdf)
Amendment Request
(Adobe pdf)
Response to Denied Amendment (Adobe pdf)
Confidential Communications Request (Adobe pdf)
Restriction Request (Adobe pdf)
HIPAA Complaint (Adobe pdf)



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