Need to check on your spouse's claims? Did you recently move and would like to update each member of your family’s address at one sitting?
These are two perfect examples of when a signed Release of Information Form is required.
With a signed form on file, Optima Health will allow the person(s) you authorize to obtain and/or change your health information. For example you could designate someone to do any or all of the following with an ROI:
- Obtain claims information
- Change your primary care physician (PCP)
- Update an address, phone or email
- Update other policy information
When a Release of Information Form is on file, the signed form authorizes Optima Health to make the change or release specified information to the designated agent.
Please note:
- The ROI is valid until the end of your insurance contract unless you elect a different time frame on the form.
- You may revise or revoke an ROI at any time by contacting Optima Health.
- You must have a witness sign this form. The witness cannot be the person named on the form.
- In order for someone other than the subscriber (the employee in whose name the insurance has been purchased, designated by an *01 at the end of the Member ID number) to obtain or change information on a minor dependent, the subscriber must complete and return an ROI.
- The signed form must be received by Optima Health in order for it to be effective.
- Include your Member ID number
Once this form is on file, you may also authorize your spouse to make specified changes when visiting My Optima. Simply follow the prompts for authorizing spouse privileges to view claims, referrals and authorizations. If you have any questions, contact Member Services.
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