The IBC Personal Representative Process

To protect the privacy of our members’ medical records and personal health information, and to be in compliance with the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Independence Blue Cross (IBC) is not able to authorize Personal Representative Requests over the phone or through ibxpress.com.

How to become a Personal Representative for an IBC member*:

A Personal Representative Request Form must be completed and submitted by mail:
- Member Correspondence
  P.O. Box 41890
  Philadelphia, PA 19101-1890
- Or faxed: 215-241-2042 or 888-457-3013
All submissions MUST include a copy of one of the following documents (notary’s seal must be visible on photocopies):

Power of Attorney
Guardianship papers
Death certificate (when requesting the medical records of a deceased member)

IBC will send a letter acknowledging receipt of the request and verifying the personal representative’s authority to make health-related decisions on behalf of the member.

Additional Personal Representative Information

Notice of Privacy Practices

* A member may revoke the rights of his or her personal representative at any time.