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.
Would you like to:
Forms for Members
Online Access / PHI Disclosure Form
Member Authorization to Obtain PHI
Member Authorization to Release PHI
Transition of Care Request Form
Member Appeal
Request for Network Exception
Network Exception Request Form
Member Reimbursements*
Member Reimbursement Form 
submit your request in My Plan
Travel Reimbursement Form submit your request in My Plan
Verifications
Out-of-Area Dependent Coverage Verification Form
*Claim and reimbursement forms may not be applicable to all plans. Be sure to check your benefit details in your summary plan description prior to submitting a claim or reimbursement form.
Some forms on this page are in PDF format and require Adobe Reader to open.
