DOCUMENTS & FORMS

Forms you may need

We've put together the most common documents and forms you might need for things like filing claims or reviewing your coverage.

Enrollment

Use these resources to help you enroll in a plan.

PDF icon2021 Enrollment Form

PDF icon2022 Enrollment Form

Grievances & Appeals

Use these forms to file an appeal about coverage or payment decisions or to file a grievance if you have concerns about your plan, providers or quality of care.

PDF iconMember Appeal Form

PDF iconMember Grievance Form

PDF iconDiscrimination Grievance Form

*Shared Health Dual Plus Star Rating: Plan too new to be measured