Medicare forms and documents for Daytona Beach, FL.

Bright Health'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 Health member.

Appointing a representative

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

Additional resources

Audiology directory
Authorization to share personal information
Automatic premium payment authorization form
Bright Extra Benefits (optional) enrollment form
Dental directory
Medicare reimbursement claim form
Multi-language interpreter services
Notice of nondiscrimination
Over the Counter Coverage
Pharmacy directory
Provider directory
Scope of appointment confirmation
Vision directory

Prescription Drug Coverage

Comprehensive Formulary
Monthly formulary changes
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

Ready to find your Medicare Advantage plan?
Compare plans and enroll.

Give us a call for some hands-on help. We're happy to answer questions and get you covered. 844-667-5502 (TTY: 711)

Want to be contacted by a licensed sales representative about Bright Health plans? Fill out this form and we will be in touch.

By entering my phone number and/or email address, I agree that Bright Health and/or a sales agent may call or email me, provide me with information about the plan, and answer any questions I may have.

Last Updated: Tues Oct 1 2019

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Bright Health plans are HMOs and PPOs with a Medicare contract. Bright Health’s New York D-SNP plan is an HMO with a Medicare contract and a Coordination of Benefits Agreement with New York State Department of Health. Our plans are issued through Bright Health Insurance Company or one of its affiliates. Bright Health Insurance Company is a Colorado Life and Health company that issues indemnity products, including EPOs offered through Medicare Advantage. An EPO is an exclusive provider organization plan that may be written on an HMO license in some states and on a Life and Health license in some states, including Colorado. Enrollment in our plans depends on contract renewal.

This information is not a complete description of benefits. Call 844-667-5502 | TTY:711 for more information.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

You must continue to pay your Medicare Part B premium.

Every year, Medicare evaluates plans based on a 5-star rating system.

Medicare beneficiaries may also enroll in Bright Health Medicare Advantage plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov 

Bright Health Medicare Advantage plans are plans with a network of doctors, hospitals, pharmacies, and other providers. Out-of-network/noncontracted providers are under no obligation to treat Bright Health members, except in emergency situations.

Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. You must generally use network pharmacies to fill your prescriptions for covered Part D drugs.

Other providers are available in our network. Most network providers participate through our Care Partner.

Bright Advantage Special Care (HMO SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) through 2021 based on a review of Bright Advantage Special Care (HMO SNP) Model of Care.

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