Medicare forms and documents for Phoenix and Tucson.
Bright HealthCare's job is not complete when you enroll in a Medicare Advantage plan. We are available to help throughout your healthcare experience. View some of our additional resources you may need while a Bright HealthCare member.
2022 forms and documents
Do you want to give a friend, family member or lawyer the right to make some decisions for you? You can give someone you trust the right to act on your behalf. Just fill out this appoint a representative form and mail to the address below. The appointment lasts up to a year unless you cancel it first.
Bright Health PO Box 853959 Richardson, TX 75085-3959
Appointing a representative
Automatic Premium Payment Authorization Form English Español 中文
Disenrolling from Bright Health
Multi-language interpreter services
National Coverage Determination (NCD) Information
Notice of nondiscrimination
Medicare reimbursement claim form
Authorization to Share Personal Health Information (ASPI)
Enrollment Form
Enrollment Form HMO English Español
Enrollment Form CSNP (Chronic Conditions) English Español
Enrollment Form CSNP (Mental Health) English Español
Summary of Benefits
English H4853001 Español H4853001
English H4853002 Español H4853002
English H4853016 Español H4853016
English H4853017 Español H4853017
English H4853018 Español H4853018
English H4853020 Español H4853020
Evidence of Coverage
Star Ratings
Annual Notice of Changes
2021 forms and documents
Do you want to give a friend, family member or lawyer the right to make some decisions for you? You can give someone you trust the right to act on your behalf. Just fill out this appoint a representative form and mail to the address below. The appointment lasts up to a year unless you cancel it first.
Bright Health PO Box 853959 Richardson, TX 75085-3959
Appointing a representative
Disenrolling from Bright Health
Multi-language interpreter services
National Coverage Determination (NCD) Information
Notice of nondiscrimination
Medicare reimbursement claim form
Authorization to Share Personal Health Information (ASPI)
Comprehensive Formulary
Coverage determination request form
Extra financial help for prescription drugs
Medication Therapy Management program
Prescription drug transition policy
Prior authorization criteria
Quality assurance and utilization management
Redetermination of prescription drug denial request form
Reimbursement claim form
Step therapy criteria
Safe use of opioid pain medication – information for Medicare Part D patients
Mail order summary
Mail order form
Enrollment Form
Extra Optional Benefits Enrollment Form
Annual Notice of Changes
H4853001 English
H4853001 Español
H4853001 中文
H4853002 English
H4853002 Español
H4853003 English
H4853003 Español
H5841003 English
H5841003 Español
H5841004 English
H5841004 Español
H5841008 English
H5841008 Español
Evidence of Coverage
Star Ratings for HMO Plans
2021 LIS Premium Summary
2020 LIS Premium Summary
Website Last Updated: Oct 14, 2022
Y0127_Bright_Health