Forms marked * are interactive, so you can type information right into them. Follow the instructions on the form to find out where to send it once you’ve completed filling it out.
- Change PCP form*
- Change of status or plan form*
- MyPriority change of status or plan form*
- Member reimbursement form*
- Medicare member medical expense reimbursement form
- Medicare Part D Prescription Drug Claim form*
- Medicare reimbursement form, out-of-country health care expenses*
- HIPAA Authorization form*
- HIPAA Authorization form, Spanish*
- Revocation of HIPAA Authorization form*
- Revocation of HIPAA Authorization form, Spanish*
If you have questions, contact our customer service team by calling the number on the back of your membership card.