Member Forms

Forms are an important part of managing your health plan expenses. For your convenience, commonly requested member forms are available below. (Note: If you have an FSA, HRA or HSA, log in to mymedica.com for the form appropriate for your account.)

Members Through Work

Claim Form – Medical
Claim Form – Prescription
ID Card Request
Primary Care/Home Clinic Change Request (Medica Elect, Essential and Focus only)

Individual and Family Members

Claim Forms

Change Forms

Other Forms

Document and Policy Document Request

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