Medicare forms and documents for Omaha.
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.
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
Coverage determination request form
Prior authorization criteria
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
Extra Optional Benefits Enrollment Form
Annual Notice of Changes
Evidence of Coverage
2021 LIS Premium Summary
2020 LIS Premium Summary
Website Last Updated: Oct 15 2021