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    • 2025 Individual Plan Updates Brochure (PDF)
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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)
  • 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 Fax Order Form (PDF)
  • Pharmacy Reimbursement Claim Form (PDF)

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

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