Forms & 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.

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Authorizations

PDF icon Online Access / PHI Disclosure Form

PDF icon Member Authorization to Obtain PHI

PDF icon Member Authorization to Release PHI

PDF icon Transition of Care Request Form

Member Appeal

PDF icon Member Appeal Form

Member Reimbursements

PDF icon Standard Medical Claim Form

PDF icon Standard Dental Claim Form

PDF icon Member Reimbursement Form  green starsubmit your request in My Plan

Offsite IconFitness Reimbursement green starsubmit your request in My Plan

 

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