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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)
  • 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)
  • Nevada Claim Form (PDF)
  • Member PHI Release Authorization Form (PDF)
  • Coordination of Benefits Form (PDF)
  • Applied Behavioral Analysis (ABA) Authorization Form (PDF)
  • ACA Individual Plan Member Change 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 Group Services representative.

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