Important Member Forms and Documents

Find the forms and documents you need to get the most out of your health plan.

Do you have questions or need help with a form? Call Member Services, 24 hours a day, seven days a week, at 1-833-704-1177 (TTY 1-855-534-6730).

• Authorization for Disclosure of Health Information (PDF)
• Personal Representative Request Form  (PDF)
• Health Risk Assessment Form (PDF)
• About Your Transportation Benefits (PDF)
• Request for Reimbursement of Medical Transportation (PDF)