Authorization to see more of Blue365

By clicking the “I AGREE” button, below, I authorize CareFirst BlueCross BlueShield  to disclose to Blue Cross and Blue Shield Association ("BCBSA"):

• The fact that I am enrolled in a CareFirst BlueCross BlueShield product and my IP address.

This authorization does not permit CareFirst BlueCross BlueShield  to disclose any other information.

I understand that BCBSA needs to know I am enrolled in a CareFirst BlueCross BlueShield product to make discounts available to me.

Once I click on a link to visit BCBSA’s Blue365 website, the fact that I am enrolled in a CareFirst BlueCross BlueShield product and my IP address will be disclosed to BCBSA. Although CareFirst BlueCross BlueShield will not give BCBSA my name or any other information about me, I understand that BCBSA’s Blue365 website is not subject to federal health information privacy laws and, therefore, could re-disclose the fact that I am enrolled in a CareFirst BlueCross BlueShield product and my IP address (subject to its privacy policies and any applicable state laws). I acknowledge that the Blue365 website includes products and services that are not health related.

This authorization is voluntary. CareFirst BlueCross BlueShield will not condition my enrollment in a health plan or eligibility or payment for benefits on receiving this authorization. I revoke this authorization and it expires immediately when I close the browser window after using the Blue365 website. When I revoke this authorization, the revocation will not affect any disclosure of the fact I am enrolled in a CareFirst BlueCross BlueShield product that CareFirst BlueCross BlueShield made before the revocation. BCBSA may receive payment from vendors under the Blue365 program.

I have had full opportunity to read and consider the contents of this authorization. I understand that, by clicking on the “I AGREE” button, below, I am confirming my authorization for the use and disclosure of information about me, as described in this form.

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