Medicare forms and documents for New York City.

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

English Español

Automatic Premium Payment Authorization Form English Español 中文


Disenrolling from Bright Health


Multi-language interpreter services

English


National Coverage Determination (NCD) Information

English Español 中文


Notice of nondiscrimination

English Español 中文


Medicare reimbursement claim form

English

Español


Authorization to Share Personal Health Information (ASPI)

English Spanish Chinese

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

English Español

Comprehensive Formulary

List of Formularies

Monthly formulary changes

English

Coverage determination request form

English

Extra financial help for prescription drugs

Medication Therapy Management program

Prescription drug transition policy

Prior authorization criteria

English

Quality assurance and utilization management

Redetermination of prescription drug denial request form

English

Reimbursement claim form

English Español

Step therapy criteria

English

Safe use of opioid pain medication – information for Medicare Part D patients

English

Mail order summary

English

Mail order form

English Español

Disenrolling from Bright Health


Multi-language interpreter services

English


National Coverage Determination (NCD) Information

English Español 中文


Notice of nondiscrimination

English


Website Last Updated: Jan 4, 2022

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