當您投保聯邦醫療保險優惠計劃後，Bright HealthCare的工作還沒結束。我們可以在您的醫療健保體驗中隨時提供幫助。查看成為Bright HealthCare會員後您可能需要的一些額外資源。

聯邦醫療保險表格和文件。

查詢與聯邦醫療保險和Bright HealthCare聯邦醫療保險優勢相關的實用文件和連結，讓您的醫療健保體驗盡可能簡單且無意外花費。

[MARKET_NAME]使用的聯邦醫療保險優惠計劃表格和文件 - Bright HealthCare

2022表格和文件

Do you want to give a friend, family member or lawyer the right to make some decisions for you? You can give someone you trust the right to act on your behalf. Just fill out this [appoint a representative form](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-aor-form.pdf) and mail to the address below. The appointment lasts up to a year unless you cancel it first.

Bright Health
PO Box 853959
Richardson, TX 75085-3959  

指定一名代表

[English](https://cdn1.brighthealthplan.com/docs/ma-resources/medicare_aor_form.pdf)
[Español](https://cdn1.brighthealthplan.com/docs/ma-resources/cms1696spanish.pdf)


指定一名代表

[組織裁定、上訴和申訴](https://zh.brighthealthcare.com/medicare-advantage/resource/file-grievance)


上訴與申訴

Automatic Premium Payment Authorization Form
[English](https://cdn1.brighthealthplan.com/docs/ma-resources/2022_MA_appa.pdf)
[Español](https://cdn1.brighthealthplan.com/docs/ma-resources/2022_MA_appa_SP.pdf)
[中文](https://cdn1.brighthealthplan.com/docs/ma-resources/2022_MA_appa_CH.pdf)

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[從Bright Health退保](https://zh.brighthealthcare.com/medicare-advantage/resource/disenrollment)

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[額外幫助 (Extra Help) (LIS) 摘要](https://cdn1.brighthealthplan.com/docs/ma-resources/lis/2022-LIS-Premium-Summary.pdf)

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多語言口譯服務

[English](https://cdn1.brighthealthplan.com/docs/ma-resources/MA22_ALL_1557NonDiscrim_EN.pdf)

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全美承保裁定 (NCD) 資訊

[English](https://cdn1.brighthealthplan.com/docs/ma-resources/ncd_notice.pdf)
[Español](https://cdn1.brighthealthplan.com/docs/ma-resources/ncd_notice_es.pdf)
[中文](https://cdn1.brighthealthplan.com/docs/ma-resources/ncd_notice_cn.pdf)

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非歧視聲明 

[English](https://cdn1.brighthealthplan.com/docs/ma-resources/MA22_ALL_1557NonDiscrim_EN.pdf)
[Español](https://cdn1.brighthealthplan.com/docs/ma-resources/MA22_ALL_1557NonDiscrim_SP.pdf)
[ 中文](https://cdn1.brighthealthplan.com/docs/ma-resources/MA22_ALL_1557NonDiscrim_CH.pdf)

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聯邦醫療保險報銷費用申請表格

[English](https://cdn1.brighthealthplan.com/docs/ma-resources/Medicare-Claim-Reimbursement-Form.pdf)

[Español](https://cdn1.brighthealthplan.com/docs/ma-resources/Medicare-Claim-Reimbursement-Form_SP.pdf)

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分享個人資料授權 (ASPI)

[English](https://cdn1.brighthealthplan.com/docs/ma-resources/2022_BH_MA_ASPI_Form.pdf) [Spanish](https://cdn1.brighthealthplan.com/docs/ma-resources/2022_BH_MA_ASPI_Form_SP.pdf) [Chinese](https://cdn1.brighthealthplan.com/docs/ma-resources/2022_BH_MA_ASPI_Form_CH.pdf)

額外資源

[下載綜合性藥方集](https://zh.brighthealthcare.com/medicare-advantage/drug-search)

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[查看更多藥房文件](https://zh.brighthealthcare.com/medicare-advantage/drug-search)


處方藥保險

__投保表格__

Enrollment Form HMO
[English](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-enrollment-forms/2022_MA_Enrollment_Forms_FL_PALM_BEACH_HMO.pdf)
[Español](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-enrollment-forms/2022_MA_Enrollment_Forms_FL_PALM_BEACH_HMO_ES.pdf)

Enrollment Form PPO
[English](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-enrollment-forms/2022_MA_Enrollment_Forms_FL_PALM_BEACH_PPO.pdf)
[Español](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-enrollment-forms/2022_MA_Enrollment_Forms_FL_PALM_BEACH_PPO_ES.pdf)

Enrollment Form CSNP
[English](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-enrollment-forms/2022_MA_Enrollment_Forms_FL_PALM_BEACH_CSNP.pdf)
[Español](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-enrollment-forms/2022_MA_Enrollment_Forms_FL_PALM_BEACH_CSNP_ES.pdf)

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__福利摘要__

[英文H4709039](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H4709039_fl-ftlp_EN.pdf)
[Español H4709039](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H4709039_fl-ftlp_ES.pdf)

[英文H4709033](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H4709033_EN.pdf)
[Español H4709033](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H4709033_ES.pdf)

[英文H4709031](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H4709031_fl-ftlp_EN.pdf)
[Español H4709031](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H4709031_fl-ftlp_ES.pdf)

[英文H4709011](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H4709011_EN.pdf)
[Español H4709011](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H4709011_ES.pdf)

[英文H4709032](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H4709032_EN.pdf)
[Español H4709032](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H4709032_ES.pdf)

[英文H3281010](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H3281010_fl-ftlp_EN.pdf)
[Español H3281010](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-SOBs/SB_MA22_H3281010_fl-ftlp_ES.pdf)

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__承保證明__

[英文H4709039](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-EOCs/EOC_MA22_H4709039_EN.Pdf)

[英文H4709033](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-EOCs/EOC_MA22_H4709033_EN.Pdf)

[英文H4709031](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-EOCs/EOC_MA22_H4709031_EN.Pdf)

[英文H4709011](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-EOCs/EOC_MA22_H4709011_EN.Pdf)

[英文H4709032](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-EOCs/EOC_MA22_H4709032_EN.Pdf)

[英文H3281010](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-EOCs/EOC_MA22_H3281010_EN.Pdf)

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__年度變動通知__

[英文H4709001](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-ANOCs/ANOC_MA22_H4709001_EN.pdf)

[英文H4709003](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-ANOCs/ANOC_MA22_H4709003_EN.pdf)

[英文H4709011](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-ANOCs/ANOC_MA22_H4709011_EN.pdf)

[英文H4709024](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-ANOCs/ANOC_MA22_H4709024_EN.pdf)

[英文H4709025](https://cdn1.brighthealthplan.com/docs/ma-resources/2022-ANOCs/ANOC_MA22_H4709025_EN.pdf)


計劃文件

*網站最後更新日期：2022年10月14日*

*Y0127_Bright_Health*