The HIPAA Authorization Form provides permission for your health care provider or health plan to disclose personal information about you and, if applicable, the dependents on your policy to Colonial Life and our authorized representatives.

Users are prompted for authorization electronically when filing online. However, if you skip authorization and it is later determined that a doctor verification is required to complete our review of your claim, we will first request your approval. To provide approval, download and complete the HIPAA authorization form below.