Member Resources
We are committed to keeping you informed in today’s changing health care climate.
Would you like to:
Forms for Members
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 Reimbursements
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
Verifications
ElevateHealth Out-of-Area Dependent Coverage Verification Form
Some forms on this page are in PDF format and require Adobe Reader to open.
