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Health Care Forms
Download and print a health care form.
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)
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)
Medical Necessity Request Form (PDF)
Member PHI Release Authorization Form (PDF)
Nevada Association Group Health Plan Application (PDF)
Nevada Claim Form (PDF)
New Prescription Fax Order Form (PDF)
Pharmacy Reimbursement Claim Form (PDF)
If you don't find the form you’re looking for, contact your account manager.
