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  2. For Members
  3. Member Forms

Forms

If you need help understanding or filling out a form, or if you have any questions, call Member Services at 1-833-957-0020, Monday–Friday, 8 a.m.–5 p.m.

If you cannot see or read these forms and other written material that Highmark Health Options sends you, we can communicate with you in a different way, including large print, audio, electronically, or in Braille. We can also give you information in a different language. These services are free.

To find out more about these services:

Forms
Advance Directive
picture_as_pdfAuthorization to Use and Disclose Protected Health Information
picture_as_pdfConfidential Communication Request
End-of-Life Care
picture_as_pdfMember Appeal Form
picture_as_pdfMember Grievance Form
picture_as_pdfRepresentation Consent Form
picture_as_pdfRequest for Access to Protected Health Information
picture_as_pdfRequest for Accounting of Disclosures of Protected Health Information
picture_as_pdfRequest to Amend Protected Health Information