Commonly Used Forms


Looking for Health Insurance

Individual & Family

        Application
        Additional Forms

Employer Groups (Small 1-50 Eligible Employees)

        Application for Heath Benefits - Groups with 2 or More Employees
        Uniform Employee Application English | Español
        Additional Forms

Employer Groups (Large 51+ Eligible Employees)

        Enrollment Form - Group Coverage  English | Español
        Additional Forms


Current Member

Individual & Family

        Preauthorization Form
        Plan Change Form  English | Español
        Disenrollment Form  English | Español

Employer Groups

        Group Employee Change Form  English | Español
        Small Group Disenrollment Form 
        Large Group Disenrollment From

Medicare

        Medicare Consent Form


Provider

     CAQH Data Form
     CMS 1500 Claim Form
     Access RMHP New User Registration
     Claims Action Request (CAR) Form
     Provider Dispute Resolution Form
     DME Authorization Form
     Additional Forms

Helpful Links

Good Health Formulary (English|Espanol)

Provider Directories