Need to access forms and your personal plan documents? For your privacy and protection, please login to your OhioHealthy account. Just looking for forms? The forms below are immediately available for you to download without signing in.
Forms
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OhioHealthy Network Exception Request Form
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Travel and Lodging Benefit Reimbursement Predetermination and Claim Form
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Prescription Drug Claim Form
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Prior Authorization Request Form - Fully Funded
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Prior Authorization Request Form - Level Funded
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Prior Authorization Request Form - Self Funded
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Transition of Care / Continuity of Care Form
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Transition of Care / Continuity of Care Flyer
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OhioHealthy Provider Nomination Form
Care Management from a Team of Specialists
As part of your health benefit plan, you have access to care management - a voluntary program to help you and your family deal with chronic or serious illnesses or injuries. This program is available to you at no additional out-of-pocket cost.