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The HIPAA Authorization allows you to manage your health information. In order to earn an incentive from your employer, you must agree to the HIPAA Authorization. If you have questions, contact us.
I agree that I have read this Authorization and had an opportunity to ask questions. I am allowing Truth Initiative/EX Program to use and/or share my PHI for the purposes stated in this Authorization.
Declining the HIPAA authorization means we can't let your employer know when you complete the EX Program.
This means you will not be able to receive their incentives or avoid surcharges. You also won't have access to coaching and free quitting medications.
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