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
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 中文
Enrollment Form CSNP English Español 中文
Enrollment Form DSNP English Español 中文
Summary of Benefits
English H2288001 Español H2288001 中文 H2288001
English H2288003 Español H2288003 中文 H2288003
English H2288009 Español H2288009 中文 H2288009
English H2288010 Español H2288010 中文 H2288010
Evidence of Coverage
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
Comprehensive Formulary
Monthly formulary changes
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
Evidence of Coverage
2021 LIS Premium Summary
2020 LIS Premium Summary
Website Last Updated: Oct 14, 2022
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