Medicare forms and documents for Central Florida.
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 PPO English Español
Enrollment Form CSNP English Español
Summary of Benefits
English H4709039 Español H4709039
English H4709027 Español H4709027
English H4709031 Español H4709031
English H4709025 Español H4709025
English H4709026 Español H4709026
English H3281010 Español H3281010
Evidence of Coverage
Annual Notice of Changes
Website Last Updated: Oct 14, 2022
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