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Employee Health Coverage Survey |
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Use this form when initially enrolling in HealthShare™. This helps determine program eligibility.
Click here to open the form. |
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Change and Cancellation Form |
Use this form to:
- Add dependents to coverage
- Update your contact information such as address or phone number
- Change your Primary Care Physician
- Request an ID Card replacement
- Switch HealthShare™ coverage options
- Cancel HealthShare™ coverage
Click here to open the form. |
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Health Risk Appraisal Form |
Use this form:
- When initially enrolling in HealthShare™ to determine if you need to meet with a Health Advisor.
Click here to open the form. |
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Health Education Verification Form |
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This form is used when you attend a non-HealthShare™ sponsored class that you want to count toward your Wellness Program health class requirement. Take the form with you to the class and have it signed by the instructor.
Before attending the class, contact HealthShare™ to see if you can receive credit for the class.
Click here to open the form. |
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Complaint Resolution Form |
Use this form when:
- You have a question about a submitted claim
- It appears a claim may have been paid incorrectly
- A claim may have been denied in error
- You've received a bill from a provider and you feel the amount billed is more than what the HealthShare™ Program Handbook states is the member's share
- You'd like to provide any feedback to HealthShare™
Click here to open the form. |
