HIPAA authorization

HIPAA Authorization Form

Download this form if you need to submit HIPAA authorization.

Spanish HIPAA Authorization Form

Descargue este formulario para autorizar a un tercero a recibir información.

Third-Party Authorization Form

Download this form to authorize a third party to receive information. 

Tips for completing the HIPAA authorization form

Your privacy and security are important to us. To protect your personal health information, we require you to complete, sign and submit a HIPAA authorization form anytime you file a claim with Colonial Life.

By completing this form, you're providing permission for your health care provider or institution, health plan or health care clearinghouse to disclose personal information about you and, if applicable, the dependents on your policy to Colonial Life and our duly authorized representatives. This information is used solely to evaluate and administer your claim for benefits or to evaluate your eligibility for insurance.

Log in to your account to submit your HIPAA authorization form online along with your claim forms and documentation. If you don't have an account, register here. This is the fastest way to start receiving benefits. Alternatively, you can fax your form to 1-800-880-9325 or mail it to P.O. Box 100195, Columbia, SC 29202-3195.

Third-Party Authorization Form

HIPAA prohibits us from sharing any of your personal and medical information. If you would like us to communicate with a family member, friend or other third party about your claim(s), please sign this optional form, which gives us permission to share relevant information.