Forms & Documents - MotivHealth Insurance Company

Forms & Documents

GENERAL | HSA | MATERIALS

GENERAL DOCUMENTS

Employee Enrollment Form
Emergency and Out of Area Care
Large Group Risk Evaluation
Large Group Application
Short Form Health Questionnaire
Personal Health Information Authorization Disclosure
How We Evaluate New Technology
Member Guide

MotivHealth Insurance Privacy Policy
How to File a Claim
How to File a Complaint
Medical Reimbursement Form
Member Rights and Responsibilities
Precertification, Appeals, and Utilization Management
Preauthorization List
PA General Update
DMR Form

HSA DOCUMENTS

Beneficiary Designation
Change of Personal Information
Closure Request
Contribution Form
Distribution Excess HSA Contributions
Electronic Transfer of Funds
HSA Letter of Medical Necessity
Instructions upon Death

Instructions Upon Divorce
Mistaken Distribution
Partial Transfer Request
Reimbursement
Return Mistaken Contribution
Rollover Request
Transfer Request

DESIGNED MATERIALS

Member Guides
Posters

Media Downloads

Copyright © 2020 MotivHealth Insurance Company. All Rights Reserved | Privacy Policy

Copyright © 2020 MotivHealth Insurance Company.
All Rights Reserved | Privacy Policy

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