HIPAA privacy forms and Certificate of Group Plan Coverage

By law, the APWU Health Plan is required to protect the privacy of your personal health information. The APWU Health Plan is also required to give you this Notice to tell you how the APWU Health Plan may use and/or share your personal health information held by the APWU Health Plan. To learn more about our privacy practices, see our Notice of Privacy Practices.

HIPAA privacy forms

To download these forms, you will need the free Adobe Acrobat Reader installed on your computer.

Download Acrobat Reader  (external link)

Certificate of Group Health Plan Coverage

What is a Certificate of Group Health Plan Coverage?

This certificate is evidence of your coverage under this plan.

Why might I need a Certificate of Group Health Plan Coverage?

You can use this certificate when getting health insurance or other health care coverage. You new plan must reduce or eliminate waiting periods, limitation, or exclusions for health-related conditions based on the information in the certificate as long as you enroll within 63 days of losing coverage under this Plan. If you have been enrolled with us for less than 12 months, but were previously enrolled in other FEHB plans, you may also request a certificate from those plans.

When is a Certificate of Group Health Plan Coverage Produced?

If you leave the FEHB Program, we will automatically generate a Certificate of Group Health Plan Coverage that indicates how long you have been enrolled with us.

How do I request a copy?

Simply contact the APWU Health Plan Customer Service Department. You may request a certificate up to two years from your termination date from the plan.

Call: 1-800-222-APWU (2798)

The APWU Health Plan reserves the right to modify this legal disclaimer and privacy policy at any time. If you have questions about the privacy statement or the practices of this web site, you should contact