Notice of Privacy Practices

The privacy components of the Health Insurance Portability and Accountability Act (HIPAA) took effect on April 14, 2003. BlueCross BlueShield of Western New York continues to comply with federal laws and to meet the required standards for protecting and securing your protected health information (PHI).

To help you understand our responsibilities and your rights under this new legislation, we are providing you with a Notice of Privacy Practices, and the Authorization Forms necessary to share your PHI.

BlueCross BlueShield's Notice of Privacy Practices describes:

  • How we may use and disclose your protected health information.
  • Your rights to obtain access to your protected health information.
  • Our legal duties relative to your protected health information.

To save the PDF version of our Notice of Privacy Practices (200KB File size) to your computer, right-click here and choose “Save Target As...” (Adobe Reader required)

Authorization Forms

In keeping with the HIPAA Privacy Regulations, the following forms should be used when you wish to give us permission to share your protected health information:

If you wish to have your general health information released to someone PLUS information regarding HIV/AIDS and/or Mental Health, Alcohol and Substance Abuse, then Form 2 (A) plus one or both of the other forms need to be completed.

Please print the appropriate form(s), complete and return to the Contact Office given below. We cannot accept the form(s) electronically, as we require your signature on the form(s).

Contact Office - Mailing Address:


Privacy Department

PO Box 80

Buffalo, NY 14240


Privacy Department

PO Box 15013

Albany, NY 12212