Authorization for Disclosure of Medical Information to the Group Term Life Program - Utah

Authorization for Disclosure of Medical Information to the Group Term Life Program - Utah

Authorization for Disclosure of Medical Information to the Group Term Life Program is a legal document that was released by the Utah Retirement Systems - a government authority operating within Utah.

FAQ

Q: What is the Authorization for Disclosure of Medical Information to the Group Term Life Program?A: It is a form that allows the disclosure of your medical information to the Group Term Life Program.

Q: Why do I need to authorize the disclosure of my medical information?A: You need to authorize the disclosure of your medical information to determine your eligibility for the Group Term Life Program.

Q: Who is the Group Term Life Program for?A: The Group Term Life Program is for eligible individuals who meet the criteria.

Q: Is the authorization form specific to Utah?A: Yes, the authorization form is specifically for Utah.

Q: Can I refuse to authorize the disclosure of my medical information?A: Yes, you can refuse to authorize the disclosure of your medical information, but it may impact your eligibility for the Group Term Life Program.

Q: How long is the authorization valid for?A: The authorization is valid for one year from the date of signature.

Q: What happens to my medical information once it is disclosed?A: Your medical information is used to determine your eligibility for the Group Term Life Program and is kept confidential.

ADVERTISEMENT

Form Details:

  • Released on July 7, 2016;
  • The latest edition currently provided by the Utah Retirement Systems;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below{class="scroll_to"} or browse more documents and templates provided by the Utah Retirement Systems.

Download Authorization for Disclosure of Medical Information to the Group Term Life Program - Utah

4.3 of 5 (42 votes)
  • Authorization for Disclosure of Medical Information to the Group Term Life Program - Utah

    1

  • Authorization for Disclosure of Medical Information to the Group Term Life Program - Utah, Page 2

    2

  • Authorization for Disclosure of Medical Information to the Group Term Life Program - Utah, Page 1
  • Authorization for Disclosure of Medical Information to the Group Term Life Program - Utah, Page 2
Prev 1 2 Next
ADVERTISEMENT