Member Forms


Legal

  • Advanced Directive. Use this form to gives instructions for your health care in the event that you are no longer able to make or communicate those decisions yourself.
  • CMS Appointment of Representative Form. Use this form to appoint someone to represent you on formal matters, such as appeals or grievances.
  • Release of Information Form. Use this form to allow loved ones to access your protected health information.
  • VA Release of Information Form. Use this form to authorize the Department of Veterans Affairs to release health-related information to those you designate.

Prescription Drugs

Prior Authorization

  • Prior Authorization Form. You or your provider can use this form to request prior authorization for services that require it.

Reimbursement

This page was last updated 09/04/2024