At United Concordia, we place the highest priority
on the privacy of each of our enrollees and we strive
to protect that privacy.
As a TRICARE Dental Program (TDP) member, it's important
that you are aware of your privacy rights under the Health
Insurance Portability and Accountability Act of 1996
(HIPAA). These include the right to:
Inspect and obtain a copy of your medical/dental records.
Request restrictions to any part of your protected health information (PHI).
Request alternative means of communicating your PHI.
Request amendments to your PHI.
Request a record of disclosures made of your PHI.
File a written complaint if you feel your rights are violated.
PHI is any individually identifiable health information such
as your date of birth, address, e-mail address or anything that
may relate to your past, present or future physical or
mental health.
Another important part of your privacy is the release of
your PHI. United Concordia must follow HIPAA privacy rules
when discussing your family members' health information
with you.
When you call United Concordia about a dental claim or other
TDP benefit issues on behalf of someone, like your spouse
or adult child, our customer service representatives will
be happy to assist you, but certain privacy practices must
be followed first.
Generally, if you call United Concordia on behalf of your
spouse you will need to submit a Request and Authorization
for Disclosure of Health Information form before the PHI
can be released. If you call United Concordia to verify
enrollment or claim information for dependent children
under the age of 18, the caller must be listed with an
active enrollment or no information will be released.
Information can be obtained for children under the age
of 18 by persons not covered by the TDP if a Custodial
Parent Release, Custodial Order or Power of Attorney
form is on file with TDP Customer Service.
You can find this form by:
Click on the “Enrollees” tab.
Click on “Forms/Materials” in the left hand
navigation column.
Click on “HIPAA and Privacy Release Form” (if a member
is 18 years of age or older).
Click on “Custodial Parent Release Form” (if member is
under 18 years of age and custodial parent/guardian is not
enrolled in the TDP).
Note: If you have questions regarding submission of the custodial
documentation, please contact TDP Customer Service at 800-866-8499
(CONUS), 888-418-0466 (OCONUS toll free) or
717-975-5017 (OCONUS, not toll free).
United Concordia is committed to protecting you and
your family's health information. Submitting
the Request and Authorization for Disclosure of Health
Information form ensures that United Concordia has authorization
to release specific information to the persons indicated on the form.
For more information on how the Military Health System
may use and disclose your PHI, please review the Notice
of Privacy Practices. To obtain a copy of the notice do one
of the following:
Contact your military treatment facility (MTF)
HIPAA Privacy Officer or access your MTF Web site.
