Explore healthy choices with Blue365®

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.

Authorization to see more of Blue365

By clicking the “I AGREE” button, below, I authorize the Service Benefit Plan to disclose to each Blue365 vendor on whose Web site link I click:

The fact that I am enrolled in the Service Benefit Plan.

This authorization does not permit the Service Benefit Plan to disclose any other information.

I understand that Blue365 vendors need to know I am enrolled in the Service Benefit Plan to give me discounts.

Once I click on a link to visit a Blue365 vendor’s Web site, the fact that I am enrolled in the Service Benefit Plan will be disclosed to that vendor. Although the Service Benefit Plan 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 the Service Benefit Plan (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. The Service Benefit Plan 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 the Service Benefit Plan that the Service Benefit Plan made before the revocation. The Service Benefit Plan 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 on the “I AGREE” button, below, I am confirming my authorization for the use and disclosure of information about me, as described in this form.

I AGREE

I WOULD LIKE TO PRINT A COPY OF THIS AUTHORIZATION

Page last updated: October 18, 2012

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