Forms & Documents

Some forms are specific to the type of plan you have. Others are generic. See below for our most requested forms. Or click on your plan type further down the page to see more options.

If you have questions about which form to use, call the toll-free number on the back of your Healthfirst Member ID card.

Commonly Used Forms:

Authorization to Release Protected Health Information (PHI)

Complete this form to allow Healthfirst to share your health or coverage information with a family member, caregiver or other trusted person or organization. Only complete this form if you want to authorize Healthfirst to discuss your Protected Health Information (PHI) with someone other than you.

Download the PHI Release Form

Appointment of Representative Form (AOR) for All Medicare Plans

Complete this form if you want to name someone you trust to act on your behalf to ask for an exception or appeal, or to make a complaint with Healthfirst.

Download the AOR Form

Viewing documents for:

Medicare & Managed Long Term Care Plans

* = managed long-term care plan

General Forms

Helpful Member and Plan Information
Authorization Forms to Share Medical Information
Medicare Enrollment and General Benefit Forms
65 Plus Plan (HMO)
CompleteCare (HMO D-SNP)*
Connection Plan (HMO D-SNP)
Increased Benefits Plan (HMO)
Life Improvement Plan (HMO D-SNP)
Senior Health Partners*
Signature (HMO)
Signature (PPO)
Medicare Part D and OTC/Flex Forms

Plan Documents

Helpful Member and Plan Information
Authorization Forms to Share Medical Information
Medicare Enrollment and General Benefit Forms
65 Plus Plan (HMO)
CompleteCare (HMO D-SNP)*
Connection Plan (HMO D-SNP)
Increased Benefits Plan (HMO)
Life Improvement Plan (HMO D-SNP)
Senior Health Partners*
Signature (HMO)
Signature (PPO)
Medicare Part D and OTC/Flex Forms

Additional Resources

Helpful Member and Plan Information
Authorization Forms to Share Medical Information
Medicare Enrollment and General Benefit Forms
65 Plus Plan (HMO)
CompleteCare (HMO D-SNP)*
Connection Plan (HMO D-SNP)
Increased Benefits Plan (HMO)
Life Improvement Plan (HMO D-SNP)
Senior Health Partners*