Insurance Mandatory Notices

Insurance Mandatory Notices

• Policy Acknowledgment Form (PDF) -  HIPAA, SBC, Glossary and Subscriber Responsibility
  • HIPAA - Chemung County Notice of Health Information Practices (PDF)
  • SBC and Glossary - Affordable Care Act Notices
  • Subscriber's Responsibility (PDF) - Applies to all members
• COBRA Notice (PDF) - General COBRA Notice
• Creditable Coverage Notice (PDF) - For members with Medicare
• HIPPA Authorization Form (PDF)