Member forms

Forms marked * are interactive, so you can type information right into them. You may also be able to save the completed forms to your computer. See instructions on the left.

Click on these categories to see available forms:

Medicare member forms

Learn about the Medicare appeals process.

Medicare reimbursement request forms

Change your PCP, name, address, dependents, or plan

It's faster to change your PCP online. Log in to your member account and choose My health care, then Find a Doctor.

  • *Change of status or plan form
    Use this form to make changes to your name, marital status and contact information, or add or remove dependents. File within 31 days of the change.
  • *MyPriority change of status or plan form
    Use this form to make changes to your name, marital status and contact information, or add or remove dependents. File within 31 days of the change.

Enroll in or change your FSA

Enroll in or change from automatic bill payment

Order prescriptions delivered to your home

Submit a claim for us to reimburse you

Request credit against your deductible

Give or remove permission to see your personal information (HIPAA authorization)

Print a HealthbyChoice (HbC) qualifications form

File a complaint or an appeal

Learn about the steps to follow and get the forms to file a complaint, grievance, or appeal with Priority Health.

Get medical services

Healthy Michigan Plan Health Risk Assessment form (English, Spanish, and Arabic) from the Michigan Department of Health & Human Services