Medicare forms and documents for Orlando-Tampa.
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.
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
Disenrolling from Bright Health
Multi-language interpreter services
Notice of nondiscrimination
Medicare reimbursement claim form
Comprehensive Formulary
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
2020 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
Audiology directory
Authorization to share personal information
Automatic premium payment authorization form
Bright Extra Benefits (optional) enrollment form
Dental directory
Disenrolling from Bright Health
Enrollment Forms
Evidence of Coverage
H4709005 English H4709005 Español H4709003 English H4709003 Español H4709001 English H4709001 Español H3281005 English H3281005 Español H3281003 English H3281003 Español H3281001 English H3281001 Español
Medicare reimbursement claim form
Multi-language interpreter services
National Coverage Determination (NCD) Information
Notice of nondiscrimination
Over the Counter Coverage
Pharmacy directory
Provider directory
Scope of appointment confirmation
Vision directory
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
Website Last Updated: Jan 13 2021
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