Forms & Brochures

Here you'll find the forms most requested by members. Just follow the links below to download the form you need.

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Administrative and Privacy

Authorization for release of information, designation of a personal representative, and more.

Health Plans—Miscellaneous

Dental claims, subscriber submit claim, Medicare Part D appointment of representative, and more.

Health and Wellness

Fitness and Weight Loss Reimbursements, immunizations and screening tests for children, and more.

Pharmacy

Pharmacy claim form and request for prior authorization form.

Tax Forms

Overview of 1099-HC and 1095-B tax forms.