At Jefferson Health Plans, we understand the importance of keeping your personal information private, and we take our obligation to do so seriously.
Jefferson Health Plans
CHIP
Notice of Privacy Practices
Member Privacy Forms
Request for Access to Protected Health Information (PHI)
View in: English | Español
Authorization for the Use or Disclosure of PHI
View in: English | Español
Request for Amendment of PHI
View in: English | Español
Request for Restriction on the Use or Disclosure of PHI
View in: English | Español
Request for Alternative Communications
View in: English | Español
Consent for Release of Sensitive Information
View in: English | Español
Revocation/Cancellation of Authorization
View in: English | Español
Jefferson Health Plans
Everwell
Notice of Privacy Practices
Member Privacy Forms
Request for Access to Protected Health Information (PHI)
View in: English | Español
Authorization for the Use or Disclosure of PHI
View in: English | Español
Request for Amendment of PHI
View in: English | Español
Request for Restriction on the Use or Disclosure of PHI
View in: English | Español
Request for Alternative Communications
View in: English | Español
Consent for Release of Sensitive Information
View in: English | Español
Revocation/Cancellation of Authorization
View in: English | Español
Jefferson Health Plans
Individual and Family Plans
Notice of Privacy Practices
Member Privacy Forms
Request for Access to Protected Health Information (PHI)
View in: English | Español
Authorization for the Use or Disclosure of PHI
View in: English | Español
Request for Amendment of PHI
View in: English | Español
Request for Restriction on the Use or Disclosure of PHI
View in: English | Español
Request for Alternative Communications
View in: English | Español
Consent for Release of Sensitive Information
View in: English | Español
Revocation/Cancellation of Authorization
View in: English | Español
Jefferson Health Plans
Medicare Advantage
Notice of Privacy Practices
Member Privacy Forms
Request for Access to Protected Health Information (PHI)
View in: English | Español
Authorization for the Use or Disclosure of PHI
View in: English | Español
Request for Amendment of PHI
View in: English | Español
Request for Restriction on the Use or Disclosure of PHI
View in: English | Español
Request for Alternative Communications
View in: English | Español
Consent for Release of Sensitive Information
View in: English | Español
Revocation/Cancellation of Authorization
View in: English | Español