Member Forms
Important forms for members.
Find the right forms for your plan.
- Appointment of Representative form
- Bank Account Withdrawal Pre-Authorization form
- Dental Claim form
- HMO Paper Prescription Drug Coverage Determination Request – English | Spanish
- HMO Paper Prescription Drug Coverage Redetermination Request – English | Spanish
- Mail Order Pharmacy Form
- Member Standing Authorization form
- Online Medicare Complaint Form
- Online Medicare Coverage Determination form
- Online Medicare Prescription Drug Coverage Determination Request
- Online Medicare Prescription Drug Coverage Redetermination Request
- Part B Medical Reimbursement Claim form
- Part D/Prescription Drug Claim form
- Part D/Prescription Drug Coverage Determination form – English | Spanish
- Part D/Prescription Drug Coverage Redetermination form – English | Spanish
- Personal Medication List – English | Spanish
- PPO Paper Prescription Drug Coverage Determination Request – English | Spanish
- PPO Prescription Drug Coverage Redetermination Request – English | Spanish
- Waiver of Liability form
- Yearly Wellness Checklist
Johns Hopkins HealthLINK
HealthLINK gives you 24/7 access to your health plan. View your Explanation of Benefits (EOBs), check claim status, change your primary care doctor, update your personal information and more.
