HIPAA Privacy Practices and Forms

Inter-County is committed to protecting the privacy of our members' personal health information. Part of that commitment is complying with the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which requires us to take additional measures to protect personal information and to inform our members about those measures.

Notice of Privacy Practices

Describes how Inter-County may use and disclose a member’s personal health information and how a member of an Inter-County health plan can get access to this information.

• Notice of Privacy Practices

General HIPAA Information

• HIPAA Compliance
• How to Retrieve Secure Email from Inter-County

HIPAA Privacy Forms

For your convenience, download and print any of the following HIPAA forms as needed:

• Authorization to Release Information
• Request for Copies of PHI
• Request for Confidential Communication of PHI
• Request for Limitations and Restrictions of PHI
• Amendment Request
• Revocation of Access
• Request for Accounting of Disclosures of PHI
• Personal Representative Request

Mail or fax the completed and signed forms to:
Inter-County
Attn: Privacy Office
720 Blair Mill Road
Horsham, PA 19044
Fax: 215-238-7993
Phone: 215-830-2579

HIPAA Privacy Inquiries

If you have questions or comments regarding HIPAA Privacy, please submit an inquiry.