Health Care Forms

Download and print a health care form.

• Authorization for the Release of Protected Health Information (PDF)
• Employee Enrollment and Change Form (PDF)
• Employee Enrollment and Change Form - Spanish (PDF)
• Employer Group Enrollment Form (PDF)
• 2021 Individual Off Exchange Application Form (PDF)
• 2021 Individual Off Exchange Member Change Form (PDF)
• 2022 Individual Off Exchange Application Form (PDF)
• 2022 Individual Off Exchange Member Change Form (PDF)
• Coordination of Benefits Form (PDF)
• Applied Behavioral Analysis (ABA) Authorization Form (PDF)
• Nevada Claim Form (PDF)
• Primary Care Physician Change Form (PDF)
• Pharmacy Reimbursement Claim Form (PDF)
• Substance Abuse Records Release Form (PDF)
• New Prescription Mail-In Order Form (PDF)
• New Prescription Fax Order Form (PDF)
• Medical Necessity Request Form (PDF)

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