You can use this form to tell us how and where you want us to send confidential information about your protected health records.

What you’ll need:

• Your subscriber ID card, also known as enrollee ID card
• A printer to print the form
• An envelope and postage to mail the form, or a fax machine. Each form includes instructions, a mailing address and a fax number.

If you have any questions, please contact us.

Request for Confidential Communication (PDF)