Privacy Practices Notice and Forms
Privacy Practices Notice
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) helps to protect your privacy. If you are covered by a health plan, you should get a Privacy Practices Notice.
HealthSpring is required by federal and state law to give a Privacy Practices Notice to plan members. The notice explains how HealthSpring can use and share a member’s health and financial information. The notice is different than the website Privacy Statement.
Privacy Practices Notice [PDF]
Updated 10/23/2025
Privacy Forms
You have certain rights related to your privacy. To make a request regarding these rights, use a privacy form. You can:
Print out a form. Complete and sign the form, then mail it to the address shown on the form.
Request to have a certain form sent to you. Call the customer service number shown on your member ID card.
Standard Authorization Form with Instructions [PDF]
Use this form to ask HealthSpring to share your protected health information (PHI) with a certain person or entity.
Updated 10/23/2025
Use this form to ask HealthSpring for a copy of your PHI records.
Updated 10/23/2025
Request for Accounting of PHI Disclosures [PDF]
Use this form to get a record of how HealthSpring shared your PHI.
Updated 10/23/2025
Response to Denied Amendment [PDF]
If you had a request to update your PHI denied by HealthSpring, use this form. You can ask that the original request and the denial be attached to future disclosures of your PHI.
Updated 10/23/2025
Confidential Communications Request [PDF]
Do you feel your life could be in danger if you get mail at your current address? Use this form to ask HealthSpring to restrict your PHI and communicate with you at an alternate location.
Updated 10/23/2025
Use this form to ask HealthSpring to restrict your PHI from being used or shared with another person or non-covered entity under HIPAA.
Updated 10/23/2025
Privacy and Security Complaint [PDF]
Use this form to file a privacy or security complaint with HealthSpring.
Updated 10/23/2025
Privacy Questions or Concerns
Do you have questions or concerns about your privacy rights?
Call: Use the customer service number on your member ID card. Or you can call
1-877-361-7594 .Write to:
Privacy Office
HealthSpring
300 E. Randolph St.
Chicago, IL 60601-5099