Your session is about to expire

Your session will automatically expire in  seconds.

Skip Navigation Links

HIPAA Notice of Privacy Practices (NoPP) and Privacy Forms


The NoPP is a separate document from the website Privacy Statement. It is a notice that Blue Cross and Blue Shield of Montana (BCBSMT) is required by the Health Insurance Portability and Accountability Act (HIPAA) to provide to members covered under a BCBSMT insurance policy. The notice describes the way in which BCBSMT can use or disclose the Protected Health Information (PHI) that we maintain about you. Members of a self-funded plan should obtain a notice from their employer/group health plan.

Notice of Privacy Practices

Privacy Forms

Under HIPAA, you have several rights related to your privacy. For example, you can:
  • Provide authorization for BCBSMT to share your PHI
  • Request access to your PHI
  • File a complaint

To make a request, please print out and complete the appropriate form below, sign the form and mail it according to the instructions provided.

Standard Authorization Form with Instructions (with fill-in fields; click "Save" when the pop-up menu appears)   
Standard Authorization Form with Instructions   
Request to Access PHI   
Request to Amend PHI   
Request for Accounting of PHI Disclosures   
Response to Denied Amendment    
Confidential Communications Request       
Restriction Request    
HIPAA Complaint      

Privacy Questions or Concerns

If you have any questions or concerns about your privacy rights, call the number on the back of your membership card or call us at 877-361-7594. You may also write us at:

Privacy Office
P.O. Box 804836
Chicago, IL 60680-4110


Linked In
Follow us on TwitterFind us on Facebook     A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield
     Association.   © Copyright 2013 Health Care Service Corporation. All Rights Reserved
Privacy Policy