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HIPAA Notice of Privacy Practices (NoPP) and Privacy Forms


The Health Insurance Portability and Accountability Act (HIPAA) helps to protect your privacy. Under HIPAA, Blue Cross and Blue Shield of Montana (BCBSMT) must provide a NoPP to members covered by our insurance plans.

The NoPP is a separate document from the website Privacy Statement. The NoPP is a notice that tells how we can use or disclose your Protected Health Information (PHI). Please note: Members who are covered by a self-funded group health plan should receive a NoPP from their employer. Contact your employer if you need a copy of your plan’s NoPP.

Notice of Privacy Practices

Privacy Forms

Under HIPAA, you have rights related to your privacy. For example, you can:

  • Give permission for BCBSMT to share your PHI
  • Request access to your PHI
  • File a complaint

To make a request, please print out and complete the form, sign the form and mail it based on 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 member ID card. Call us at 877-361-7594. You may also write to:

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


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