The Alaska Teamster Employer Welfare Trust Plan is offering another option for surgical care, BridgeHealth, a Surgery Benefit Management Program, may be able to help you save money if you're planning any of the following surgeries:
It's easy to use, and there is no cost to you – click here to learn more!
Each eligible plan participant, including spouses and children, must complete the Authorization for Release of Protected Health Information form if they wish to authorize another individual to receive information on their behalf.
Children age 14 and above living in Alaska must complete and sign this form in order for information to be released, even to a parent. Children age 12 and above who live outside the state of Alaska must complete this form, unless their guardian wishes to provide a copy of the law in the state in which they reside, if the age is different. Please keep in mind that the requirement for children to sign the release form is mandated by the privacy laws passed by Congress. Therefore, the Trust Customer Service Office and BeneSys, Inc., the third party administrator, will not release information on children of certain ages without the signed authorization form.
A request for information, including claims information, will not be released to another party unless a signed Authorization for Release of Protected Health Information form is on file with our office.
If you need more than one Authorization for Release of Protected Health Information form, you can print additional forms by selecting the Forms link, then by selecting the Release of Health Information under General/Privacy.
If you wish to authorize another individual or individuals, please complete the form and return it to:
Alaska Teamster-Employer Welfare Trust
520 E 34th Avenue, Suite 107
Anchorage, AK 99503
Feel free to contact this office at 907-751-9700, if you have any questions.