Broker Forms
Protected Health Information Forms
Authorization to Use and Disclose Protected Health Information
A written authorization is required for HIP to share a member's protected health information with anyone, except as permitted by law. This form authorizes the release of general health information and may not be used to authorize the release of psychotherapy notes that are recorded and kept separately by a mental health professional. Use this form if you are a HIP member and would like to Authorize HIP to release or disclose your protected health information to someone else.[ download here | back to top ]
Employer Group Forms
- Underwriting Guideline Checklist
- Waiver form
- Group Application
- Prime EPO for Large Groups
- Prime EPO for Small Groups
- HIP Prime for Large Groups
- HIP Access I for Large Groups
- HIP Prime for Small Groups
- HIP Access I for Small Groups
- HIPIC Select EPO for Large Groups
- HIPIC Select EPO for Small Groups
- HIPIC Select PPO for Large Groups
- HIPIC Select PPO for Small Groups
- HIP Prime POS for Large Groups
- HIPaccessII for Large Groups
- HIP Prime POS for Small Groups
- HIPaccessII for Small Groups
- HIP PPO for Large Groups
- HIP PPO for Small Groups
- Smart Start EPO for Large Groups
- Smart Start EPO for Small Groups
