Forms & Resources

At HPI, we take our commitment to your health very seriously. That’s why 
we want to be a key source of tools and information to help you be the healthiest you 
you can be.

Would you like to:

Print a form?

Order an ID Card?

Forms for Members

 Authorizations

PDF icon Online Access/PHI Disclosure Form

PDF icon Member Authorization to Obtain PHI

PDF icon Member Authorization to Release PHI - Care Management Services

PDF icon Member Authorization to Release PHI - Claims

PDF icon Transition of Care Request Form

  

Member Appeal

PDF icon Member Appeal Form

  

Member Reimbusements

PDF icon Fitness Reimbursement Form

PDF icon Member Reimbursement Form

PDF icon Travel Reimbursement Form

 

Pre-Certification Guidelines

PDF icon Pre-Certification Guidelines