An official website of the State of Oregon
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(how to identify a Oregon.gov website)
An official website of the State of Oregon »
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Oregon law guarantees you the right to have protected health information sent directly to you instead of to the person who pays for your health insurance plan (the primary account holder).
You can have this information shared with you directly through a number of different ways:
To make this request, complete, sign, and send
this form to your insurer. You can send it by mail, fax, or email. Contact your insurance company to find out where to send your form.
Oregon Request for Confidential Communication form.
PLEASE NOTE: If you change insurance companies, you must make a new request to the new insurance company. Until your request is processed, the insurance company may continue to send your protected health insurance to the person who is paying for your health insurance.
Protected health information is individually identifiable health information your insurer has or sends out in any form. Confidential communication of protected health insurance covered under this request includes:
A .gov website belongs to an official government organization in the United States.
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Only share sensitive information on official, secure websites.
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