Medicare forms and documents for Cincinnati, Toledo, Youngstown.

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

English Español

Disenrolling from Bright Health

Multi-language interpreter services


National Coverage Determination (NCD) Information

English Español 中文

Notice of nondiscrimination


Medicare reimbursement claim form



Authorization to Share Personal Health Information (ASPI)

English Spanish Chinese

Comprehensive Formulary

List of Formularies

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

English Español

Step therapy criteria


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


Mail order summary


Mail order form

English Español

Website Last Updated: Oct 14, 2022