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).
Forms
- Authorization for Disclosure of Health Information (PDF)
- Personal Representative Request form (PDF)
- Health Risk Assessment form (PDF)
- Request for Reimbursement of Medical Transportation (PDF)
- List of Helpful Numbers form (PDF)
Print, complete and keep for easy reference. - Feeling Great Checklist form (PDF)
A checklist to guide everyday health and doctor visits.