Resources for Individual & Family Plans
Find more information about benefits, claims, and coverage here.
Benefits
Member Claim Form
View PDFMember Handbook Sample
View PDFPharmacy Claim Form
View PDFReferral Form
View PDFWritten Plan Description
View PDFLegal Forms & Notices
Coordination of Benefits (COB) Form
View PDFHow to Submit a Pre-Authorization
View PDFInteroperability and Patient Access
View PDFMedical Power of Attorney
View PDFMinor Dependent PHI Access
View PDFNondiscrimination and Languages/Accessibility
View PDFPharmacy Pre-Authorization Form
View PDFPre-Authorization Form
View PDFPre-Authorization List of Codes
View PDFTransition and Continuity of Care Member Guide
View PDFTransition and Continuity of Care Patient Request Form
View PDFHave more questions?
Speak with a Harbor Health team member
Monday-Friday, 7:00am-8:00pm CT
Saturday, 8:00am-5:00pm CT
(855) 481-0225