We designed Blue365 to support you as you make healthy decisions every day and throughout your life. So before we get started, please take a moment to read the following. We want to make sure you understand, and feel good about, any and all information related to the program.
By clicking I AGREE, I authorize BCN to disclose to each Blue365 vendor on whose Web site link I click:
This authorization does not permit BCN to disclose any other information.
I understand that Blue365 vendors need to know I am enrolled in a BCN product to give me discounts.
Once I click a link to visit a Blue365 vendor’s Web site, the fact that I am enrolled in a BCN product will be disclosed to that vendor. Although BCN 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 BCN product (subject to vendor’s own privacy policies and any applicable state laws).
I acknowledge that the Blue365 Web site includes products and services that are not health related.
This authorization is voluntary. BCN 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 Web site 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 BCN product that BCN made before the revocation. BCN 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 clicking the I AGREE button, I confirm my authorization for the use and disclosure of information about me, as described in this form. By agreeing to go forward, I certify that I am enrolled in a BCN product.
page modified 12/01/2008