HIPAA Privacy Practices and Forms
Independence Administrators is committed to protecting the privacy of plan members’ personal health information. As a Business Associate, part of that commitment is complying with the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which requires us to take additional measures to protect personal information and to inform our customers about those measures.
General HIPAA Information
HIPAA Notice of Privacy Practices
HIPAA Privacy Forms
For your convenience, download and print any of the following HIPAA forms as needed:
- Authorization to Release Information
- Request for Copies of PHI
- Request for Confidential Communication of PHI
- Request for Limitations and Restrictions of PHI
- Amendment Request
- Revocation of Access
- Request for Accounting of Disclosures of PHI
- Personal Representative Request
Mail or fax the completed and signed forms to:
Attn: Privacy Office
1900 Market Street
Philadelphia, PA 19103
HIPAA Transactions for Providers
For information about HIPAA-compliant transactions, visit the Electronic Data Interchange (EDI) Services section.
HIPAA Privacy Inquiries
If you have questions or comments regarding HIPAA Privacy, please submit an inquiry.