skip to main content

How can I authorize my spouse or other relative to have access and/or receive information on my account?


You must submit a HIPAA Authorization form for Use and Disclosure of Individually Identifiable Health Information form by fax or mail to the Judiciary Benefits Center.  You are authorizing that your spouse or other relative has permission to speak, receive information and or act, on your behalf. Once received, your account will be noted. 

For FSA account disclosure authorization, use this form - HIPAA Authorization for Use and Disclosure of Individually Identifiable Health Information - FSA.  For all non-FSA account disclosure authorizations, use this form - HIPAA Authorization for Use and Disclosure of Individually Identifiable Health Information - Non - FSA.

Get Adobe Reader       Print     Close