; Blue 365 – Health Tools and Health Product Discounts - Excellus BlueCross BlueShield
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Blue365® - Health Tools and Health Product Discounts

Excellus BlueCross BlueShield

Authorization to see more of Blue365

By clicking the "I AGREE" button, below, I authorize Excellus BlueCross BlueShield to disclose to each Blue365 vendor on whose Web site link I click:

  • The fact that I am enrolled in an Excellus BlueCross BlueShield product.

This authorization does not permit Excellus BlueCross BlueShield to disclose any other information.

I understand that Blue365 vendors need to know I am enrolled in an Excellus BlueCross BlueShield product to give me discounts.

Once I click on a link to visit a Blue365 vendor's Web site, the fact that I am enrolled in an Excellus BlueCross BlueShield product will be disclosed to that vendor. Although Excellus BlueCross BlueShield will not give the vendor my name or any other information about me, I understand that the vendor may not be subject to federal health information privacy laws and, therefore, could re-disclose the fact that I am enrolled in an Excellus BlueCross BlueShield product (subject to vendor's own privacy policies and any applicable state laws).

I acknowledge that the Blue365 Web site includes products and services that are not health related.

This authorization is voluntary. Excellus BlueCross BlueShield will not condition my enrollment in a health plan or eligibility or payment for benefits on receiving this authorization. I revoke this authorization and it expires immediately when I leave the Blue365 Web site by closing the browser window. When I revoke this authorization, the revocation will not affect any disclosure of the fact I am enrolled in an Excellus BlueCross BlueShield product that Excellus BlueCross BlueShield made before the revocation. Excellus BlueCross BlueShield may receive payment from vendors under the Blue365 program.

I have had full opportunity to read and consider the contents of this authorization. I understand that, by clicking on the "I AGREE" button, below, I am confirming my authorization for the use and disclosure of information about me, as described in this form. By agreeing to go forward, I certify that I am enrolled in an Excellus BlueCross BlueShield product.

I AGREE

I WOULD LIKE TO PRINT A COPY OF THIS AUTHORIZATION