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Transamerica



HOMEPAGE


HIPAA AUTHORIZATION

HIPAA authorization
This authorization complies with the HIPAA Privacy Rule, and its required for
all claims. A copy of this authorization will be considered as valid as the
original.

Note to claimant/personal representative: This authorization must be signed for
us to receive medical records under the Health Insurance Portability and
Accountability Act of 1996 ("HIPAA"). Although we may not need to obtain medical
records to process your claim, we must obtain this form to avoid possible delays
if medical information is needed.

Customer Portal | HIPAA Authorization | Scrolling Card | Text
Customer


HIPAA AUTHORIZATION CONTACT CARD

HIPAA authorization

Not comfortable signing electronically? You can download the HIPAA
Authorization, sign it and mail it to us at: 

Claims Department
Transamerica
PO Box 869097
Plano, TX 75086-9097

Customer Portal | HIPAA Authorization | Scrolling Card | Card
Customer