Authorization for ACERA to Assist With Claims to Insurance Carriers

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ACERA is not legally required to comply with HIPAA.  However, the integrity of your account is a high priority.  Because ACERA frequently deals with retirees’ personal health information (PHI), if you would like ACERA to step in to help resolve claims with our health insurance carriers, we’ll need you to submit a HIPAA Authorization Form to us.

HIPAA Authorization Form – Retiree authorization form that allows ACERA to release PHI

HIPAA Cancellation Form – Cancellation of authorization for PHI disclosure