Forms and Resources

At Health Plans, we take our commitment to your health very seriously. That’s why
we want to be a key source of tools and information to help you be the healthiest you you can be.

Would you like to:

Print a form?

Order an ID Card?

Authorizations

Online Access / PHI Disclosure Form

Member Authorization to Obtain PHI

Member Authorization to Release PHI - Care Management Services

Member Authorization to Release PHI - Claims

Transition of Care Request Form

Member Appeal

Member Appeal Form

Member Reimbursements

Standard Medical Claim Form

Member Reimbursement Form submit your request in My Plan

Fitness Reimbursement Form  submit your request in My Plan

Travel Reimbursement Form submit your request in My Plan

Prior Authorization

Medication Prior Authorization Request

Wellness Program

PCP Documented Plan for Biometric Improvement

Using Your Health Reimbursement Account

Managing Your HRA Debit Card Online

Physician Biometric Results Form

Some forms on this page are in PDF format and require Adobe Reader to open.