- 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)
- 2024 Individual Off Exchange Application Form (PDF)
- 2024 Individual Off Exchange Member Change 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.