Member Services: 1-800-595-0619

Privacy Policy

We protect the privacy of your personal health information. Federal and state laws protect the privacy of your medical records and personal health information. We protect your personal health information as required by these laws.

  • Your “personal health information” includes the personal information you gave us when you enrolled in this plan as well as your medical records and other medical and health information.
  • The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. We give you a written notice, called a “Notice of Privacy Practice,” that tells about these rights and explains how we protect the privacy of your health information.

To read PDFs, you will need Adobe Acrobat Reader. You can download here.

When submitting a claim for a covered service, please submit a written request with the following information:

  • Date of service
  • Provider/office name
  • Diagnosis code
  • CPT/HCPCS/REV code
  • Provider NPI
  • Amount billed
  • Any applicable medical records

For your convenience, claim forms can be found here:

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