HealthShare Forms and Documents

• HealthShare Program Handbook (PDF) - Contains the information you need to know about the HealthShare™ program.
• Change and Cancellation Form (PDF)
  • Add a dependent
  • Update address or contact information
  • Change your Primary Care Physician (PCP)
  • Request a new member ID card
  • Change your program option
  • Terminate coverage
• Complaint Resolution and Feedback Form (PDF)
  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

• Drug Formulary (PDF) - Contains a list of covered drugs.
• Employee Health Coverage Survey (PDF) - Use this form for potential enrollment in HealthShare to determine program eligibility.
• Health Education Verification (PDF) - Ask the instructor to sign this form when you attend a non-HealthShare sponsored class that you want to count toward your Wellness Program health class requirement. Before attending the class, contact HealthShare to see if you can receive credit.
• Health Risk Appraisal (PDF) - Determine if you need to meet with a Health Advisor.
• Participating Providers (PDF)