Granting Authorization To Release Protected Information

Complete the Authorization to Release Protected Information if you want us to share your information with a family member or friend. A form isn't needed unless you can't come to the phone. In that case, the Via Benefits representative will send you a form to fill out.

The Authorization to Release Protected Information (ARPI) has two levels of access, limited and full.

  • Limited - Allows sharing protected health information (PHI) with the representative, but prevents the representative from making changes to your information.

  • Full - Allows sharing PHI with the representative and allows the representative to make changes to your information. This is important if the representative manages funds or banking.

You can authorize access to your information anywhere from a single day up to indefinitely. Because sensitive information is made available to these representatives, we encourage listing only your most trusted advisors as indefinite authorized representatives.

An authorized representative with an ARPI may not complete an enrollment or the Scope of Appointment agreement on your behalf.

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Paying Medicare Part A and Part B Premiums