By selecting the "I AGREE" button, below, I authorize BlueAdvantage to disclose to each Blue365 vendor on whose website link I select:
This authorization does not permit BlueAdvantage to disclose any other information.
I understand that Blue365 vendors need to know I am enrolled in a BlueAdvantage product to give me discounts.
Once I click on a link to visit a Blue365 vendor's website, the fact that I am enrolled in a BlueAdvantage will be disclosed to that vendor. Although BlueAdvantage will not give the vendor my name or any other information about me, I understand that the vendor may not be subject to federal health information privacy laws and, therefore, could re-disclose the fact that I am enrolled in a BlueAdvantage product (subject to vendor's own privacy policies and any applicable state laws).
I acknowledge that the Blue365 website includes products and services that are not health related.
This authorization is voluntary. BlueAdvantage will not condition my enrollment in a health plan or eligibility or payment for benefits on receiving this authorization. I revoke this authorization and it expires immediately when I leave the Blue365 website by closing the browser window. When I revoke this authorization, the revocation will not affect any disclosure of the fact I am enrolled in a BlueAdvantage product that BlueAdvantage made before the revocation. BlueAdvantage may receive payment from vendors under the Blue365 program.
I have had full opportunity to read and consider the contents of this authorization. I understand that, by selecting "I AGREE", below, I am confirming my authorization for the use and disclosure of information about me, as described in this form.
I WOULD LIKE TO PRINT A COPY OF THIS AUTHORIZATION.
BlueAdvantage Administrators of Arkansas is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas. Copyright © 2002-2018 BlueAdvantage Administrators of Arkansas