Skip to main content
  • For Members
  • For Providers
  • For Employers
  • For Brokers/Agents
  • Medicaid
Health Plan of Nevada Logo
    • Claims Address
    • Exchange Plan Documents
    • Health Care Forms
    • Health Plans
    • 2025 Individual Plan Updates Brochure (PDF)
    • Online Broker Center
    • Online Eligibility Maintenance Tutorial (video)
    • Prior Authorization
Sign In
Sign In
×

More Links

For Members
For Providers
For Employers
For Brokers/Agents
Medicaid
Health Plan of Nevada Logo

Site Search ×
Home ×
    • Claims Address
    • Exchange Plan Documents
    • Health Care Forms
    • Health Plans
    • 2025 Individual Plan Updates Brochure (PDF)
    • Online Broker Center
    • Online Eligibility Maintenance Tutorial (video)
    • Prior Authorization

Health Care Forms

Download and print a health care form.

  • 2025 Individual Off Exchange Application Form (PDF)
  • 2025 Individual Off Exchange Member Change Form (PDF)
  • 2025 Nevada Small Group (1-50) Application Form (PDF)
  • 2025 Nevada Large Group (51+) Application Form (PDF)
  • 2025 Nevada Association Group Health Plan Application for Clark County (PDF)
  • 2025 Nevada Association Group Health Plan Application for State of Nevada (PDF)
  • Applied Behavioral Analysis (ABA) Authorization Form (PDF)
  • Authorization for the Release of Protected Health Information (PDF)
  • Coordination of Benefits Form (PDF)
  • Employee Enrollment and Change Form (PDF)
  • Employee Enrollment and Change Form - Spanish (PDF)
  • Employer Group Enrollment Form (PDF)
  • Medical Necessity Request Form (PDF)
  • Nevada Claim Form (PDF)
  • New Prescription Mail-In Order Form (PDF)
  • New Prescription Fax Order Form (PDF)
  • Pharmacy Reimbursement Claim Form (PDF)
  • Primary Care Physician Change Form (PDF)
  • Substance Abuse Records Release Form (PDF)

If you don't find the form you’re looking for, contact your account manager.

HELPFUL LINKS
  • Accessibility
  • Careers
  • Fraud, Waste and Abuse
  • Legal
  • Privacy
  • Quality
  • Terms of Use
  • HPN Newsroom
PARTNERS
  • Behavioral Healthcare Options
  • HealtHIE Nevada
  • UHC HPN Medicaid
  • Sierra Health and Life
  • Southwest Medical
Contact Us
  • face book
  • insta

Copyright © 2025 United HealthCare Services, Inc. All rights reserved.