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:
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
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.
