Privacy policy
Personal information (including social security number) privacy protection policy
We’re committed to safeguarding the Personal Information we receive from our customers and associates. We impose standards to maintain the confidentiality of Personal Information. And we use physical, technical, and administrative safeguards to protect it.
Personal Information is information that can be connected to you through certain identifiers which can include: name, Social Security number (SSN), driver’s license, state identification card, account, credit/debit card, passport or alien registration numbers — among other items. Personal Information does NOT include publicly available information that is lawfully made available to the general public from federal, state or local government records or widely distributed media. Our policies prohibit the unlawful disclosure of Personal Information. We share it externally only where federal and state law allows or requires it. Internally, it’s our policy to limit the access, use and disclosure of Personal Information to be in line with the job duties our associates, as well as applicable law. If you have questions about this, contact us.
Health insurance portability and accountability act of 1996 (HIPAA) notices of privacy practices
The Notices of Privacy Practices below explain how your health information may be used and/or disclosed and how to access this information in accordance with HIPAA, an important federal privacy law. The notices reflect the pharmacy obligations under federal and individual state regulations. By law, we’re required to send our members a notice with those details.
CarelonRx Home Delivery Pharmacy Notice of Privacy Practices
Privacy authorization forms
We are committed to complying with HIPAA. HIPAA allows us to use and disclose identifiable healthcare and demographic information called Protected Health Information (PHI) for Treatment, Payment and Healthcare Operations (TPO) purposes. Beyond TPO, you have the right to permit the release of your PHI by completing a Member Authorization form to grant permission for others to see your PHI. You may choose to allow your PHI to be disclosed to someone outside our company.
The following is a list of our Privacy Authorization Forms:
To view the forms if you don’t already have it, download Adobe Acrobat Reader for free.
CarelonRx Member Authorization Form (English)
CarelonRx Member Authorization Form (Spanish)
The Designation of Representative forms are to be used for a grievance or an appeal and to allow a party to act as the Authorized Representative in carrying out a grievance or an appeal.
(To designate an Authorized Representative not related to a grievance or appeal, please use the regular Member Authorization form.)
Contacting the privacy office
If you have a privacy question or need to report a privacy issue, contact the Privacy Officer, Privacy Office, P.O. Box 52072, Phoenix, AZ 85072-2072 or call the toll-free number at 1-833-255-0644 (TTY/TDD: 711).
Contacting you
We, including our affiliates or vendors, might call or text you using an automated telephone dialing system and/or a prerecorded message. But we only do this in accordance with the Telephone Consumer Protection Act (TCPA). The calls may be to let you know about pharmacy benefits and services. If you don’t want to be contacted by phone, please tell the caller and we will no longer do so.
