Table of Contents

PERSONAL INFORMATION (INCLUDING SOCIAL SECURITY NUMBER) PRIVACY PROTECTION POLICY

We are committed to safeguarding the Personal Information we receive from our customers and associates. We impose standards to maintain the confidentiality of Personal Information. And we use physical, technical, and administrative safeguards to protect it.

Personal Information is information that can be connected to you through certain identifiers which can include: name, Social Security number (SSN), driver’s license, state identification card, account, credit/debit card, passport or alien registration numbers — among other items. Personal Information does NOT include publicly available information that is lawfully made available to the general public from federal, state or local government records or widely distributed media.

Our policies prohibit the unlawful disclosure of Personal Information. We share it externally only where federal and state law allows or requires it. Internally, it’s our policy to limit the access, use and disclosure of Personal Information to be in line with the job duties our associates, as well as applicable law.

If you have questions about this, call Member Services at the toll-free number on the back of your ID card.

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) NOTICE OF PRIVACY PRACTICES

Our Notice of Privacy Practices explains how your health information may be used and/or disclosed and how to access this information in accordance with HIPAA, an important federal privacy law. The notice reflects our obligations under Federal and individual State regulations. By law, we’re required to send our fully-insured health plan members a notice with those details.

These notices generally don’t apply if you’re part of an administrative services only (ASO) group health plan. To see which type of health plan you have, and whether this applies to you, check with the person or team that handles your health plan at your employer.

Empire BlueCross Notice of Privacy Practices
Empire BlueCross Notice of Privacy Practices – Spanish
Empire BlueCross BlueShield Notice of Privacy Practices
Empire BlueCross BlueShield Notice of Privacy Practices – Spanish

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) NOTICE OF PRIVACY PRACTICES

The below Notices of Privacy Practices explain how your health information may be used and/or disclosed and how to access this information in accordance with HIPAA, an important federal privacy law.The notices reflect the pharmacy obligations under Federal and individual State regulations. By law, we’re required to send our members a notice with those details.

CarelonRx Home Delivery Pharmacy Notice of Privacy Practices
CarelonRx Specialty Pharmacy Notice of Privacy Practices

Contacting the Privacy Office

Contact us if you have a privacy questions or need to report a privacy issue.
Call Member Services at the toll-free number on the back of your ID card. Write to the Privacy Office at: CO0109-0903, 700 Broadway, Denver, CO 80273. Or email the Privacy Office at Privacy.Office@anthem.com.

California Consumer Privacy Act (CCPA) Privacy Notice (Note: This privacy notice is not applicable to Anthem’s health plans. Anthem health plan members and applicants should refer to the HIPAA Notice of Privacy Practices.)

Privacy Notice for California Residents

Privacy Authorization Forms

We are committed to complying with HIPAA. HIPAA allows us to use and disclose identifiable health care and demographic information called Protected Health Information (PHI) for Treatment, Payment and Health care operations (TPO) purposes. Beyond TPO, you have the right to permit the release of your PHI by completing a Member Authorization form to define who can see your PHI.

You may choose to allow your PHI to be disclosed to someone outside our company. To do this, fill out the appropriate form below and send to the address on the back of your ID card. If you do not have an ID card, call us at 1-317-488-6000. If you don’t already have it, download Adobe Acrobat Reader for free (you need it to view the forms).

HMO
Empire BlueCross BlueShield Downstate English - Downstate Member Authorization Form
Empire BlueCross BlueShield Downstate en Español - Formulario de autorización de miembros al Sur de NY
Empire BlueCross Upstate English - Upstate Member Authorization Form
Empire BlueCross Upstate en Español - Formulario de autorización de miembros del Norte de NY

LPPO
Empire BlueCross BlueShield Downstate English - Downstate Member Authorization Form
Empire BlueCross BlueShield Downstate en Español - Formulario de autorización de miembros al Sur de NY
Empire BlueCross BlueShield Retiree Solutions Downstate English - Downstate Retiree Solutions Member Authorization Form
Empire BlueCross BlueShield Retiree Solutions Downstate en Español - Formulario de autorización de miembros de Retiree Solutions al Sur de NY

Empire BlueCross Upstate English - Upstate Member Authorization Form
Empire BlueCross Upstate en Español - Formulario de autorización de miembros del Norte de NY
Empire BlueCross Retiree Solutions Upstate English - Upstate Retiree Solutions Member Authorization Form
Empire BlueCross Retiree Solutions Upstate en Español - Formulario de autorización de miembros de Retiree Solutions del Norte de NY

CONTACTING YOU

We, including our affiliates or vendors, might call or text you using an automated telephone dialing system and/or a prerecorded message. But we only do this in accordance with the Telephone Consumer Protection Act (TCPA). The calls may be to let you know about treatment options or other health-related benefits and services. If you do not want to be contacted by phone, just let the caller know and we won’t reach out this way in the future. You may also call toll-free at 1-844-203-3796 to place your phone number on Anthem’s internal Do Not Call list.

WEB PRIVACY STATEMENT

Your privacy is very important to us and we will make every reasonable effort to safeguard any information we collect.

What information will we collect?

Information may be collected in the following ways on this website and Application:

• If we provide user account access, you may elect to establish an account so that you can gain additional access to online service applications, health tools, health information, subscriptions or other services where it is important for us to know who you are in order to best meet your needs. Providing personal information is always voluntary.
• We may use “cookies” to help us improve this website and Application by tracking your navigation habits and to store some of your preferences. A cookie is a small file created by a website or application to store information on your computer. Cookies do not allow websites or applications to gain access to other information on your computer. Once a cookie is saved on your computer, generally only the website or application that created the cookie can read it.
• An Internet Protocol (IP) address is a number that automatically identifies the computer or mobile device that you are using to access the Internet. The IP address enables our server to send you the site pages that you want to visit or the data you want to view. The IP address may disclose the server owned by your Internet Service Provider. We use your IP address to help diagnose problems with our server and to support our administration of this website and Application.

How will information be used?

Any personal information that you provide is used for the purpose for which you provide it. For example, if you use location services to find a provider near your current location, your location is used only to facilitate that function. Or if you provide us with an email address we will only use it in a manner consistent with your consent for us to do so.

We may also gather quantitative user information, such as the number of users and the pages or data accessed, in order to perform administrative, technical, hosting or other functions that help us manage our website and Application and deliver new functionality to you. We do not sell, license, transmit or disclose personal information that you provide to us to third parties except with the following exceptions:

• Upon your authorization;
• When such disclosure is necessary to allow us and our contractors or agents to carry out treatment, payment or health care operations; or
• When required or permitted by law.

Third parties

We may work with third party service providers who may place third party persistent cookies, web beacons, or similar technologies to collect anonymous information about the use of our websites and Applications. They are not permitted to collect any personal information, and this information will be solely used for web usage analysis for a better understanding of how you use our website Application, and/or to customize our content and advertising.

What if I don’t want information about me to be collected?

Providing personal information through this website or Application is optional. Personally identifiable information will not be collected from you without your knowledge and approval. You will be told when your failure to provide information might affect your ability to enroll in or use a product or service.

If you do not wish to have your activity on our website or Application tracked, you can opt-out at any time here to discontinue first party cookie tracking of your web activity.

You also have the choice to opt-out of third party cookies, web beacons or similar technologies, if you do not want third party service providers to collect your anonymous information for marketing purposes, visit the Network Advertising Initiative (NAI) website to perform the opt-out.

Additionally, you can direct your Internet browser to notify you and seek approval whenever a cookie is being sent to your hard drive. You may also delete a cookie manually from your computer, tablet or smartphone through your Internet browser settings or other programs. You can also set your browser to refuse all cookies. Please note that some parts of this website or Application may not function properly or be available to you, if you refuse to accept a cookie or choose to disable the acceptance of cookies.

“Do Not Track” Signals

We do not respond to web browser “do not track” signals. As such, your navigation of our website and Application may be tracked as part of the gathering of quantitative user information described above. If you arrive at our website or Application by way of a link from a third party application that does respond to “do not track” requests, the recognition of any “do not track” request you have initiated will end as soon as you reach our website or Application.

Use of email and fax

We may provide email and fax links to further facilitate communication for our members and their designees and caregivers. Information collected through email may be shared with our Member Services department, other associates, or third parties that perform services on our behalf. Unless otherwise noted, email through our website or Application is not a completely secure and confidential means of communication. Non-encrypted email may be accessed and viewed by other Internet users without your knowledge and permission while in transit to us.

Also, if you request that we email or fax information about you to someone using the email and fax capabilities in this website or Application, that email or fax may not be completely secure. Please verify email addresses and fax numbers carefully before submitting such a request.

Linking to Other Sites

From time to time we will provide links to websites or applications not owned or controlled by us. We do this because we think the information might be of interest or use to you. A link to a third party website or application does not constitute or imply endorsement by us. We cannot guarantee the quality or accuracy of information presented on third party websites or applications. While we do our best to ensure your privacy, we cannot be responsible for the privacy practices of third party websites or applications. We encourage you to review the privacy practices of any website or application you visit.

HEALTH INFORMATION EXCHANGES

We may share your information with health information exchanges (HIE), which allow doctors, hospitals and payers to view/share your health information quickly and easily — for treatment, payment or health care operations. These exchanges can improve the speed, quality, safety and cost of your care. Doctors, health insurers and others using an exchange like this are required to follow the privacy and security standards set by state and federal laws.

Anthem receives information from several HIEs. If you want to opt-out of having health information in these HIEs, you may contact the following:

California: Manifest MedEx

Indiana: Indiana Health Information Exchange  

Maryland: Chesapeake Regional Information Systems for Patients

Michigan and Indiana: Michiana Health Information Network 

Ohio: CliniSync Health Information Exchange 

New York City and Long Island: Healthix 

Nevada: HealtHIE Nevada 

Tennessee: Tennessee eHealth Information Exchange 

Questions

If you have questions regarding this policy or if you would like to review or change any of your personal information we have on file, please call us at the number on the back of your ID card.

This privacy statement is effective January 1, 2020 and was most recently reviewed in December 2020. This privacy statement is subject to change. We encourage you to review it from time to time.

CONSUMER PRIVACY PROTECTION INFORMATION

• Federal Trade Commission (FTC)
• USA.gov Identity Theft website
• Consumer.gov Identity Theft website