Member Forms, Filings, and Change Requests

Find the forms you need to get the most out of your health plan.

Do you have questions or need help with a form? Call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week.

• Media release form (PDF)
• Ohio PCP change form (PDF)
• Change of address (County)
• File a grievance or appeal
• Authorized representative (PDF)
• Advanced Directive (PDF)
• HIPAA form (PDF)