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McLaren Health Plan: Your Choice for Michigan Health Insurance
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Application Form – Enroll in an Exchange Plan (Healthcare.gov)
Application Form/Request a Quote – Individual, McLaren Health Plan Off Marketplace
Authorization For Use And Disclosure of Protected Health Information
Authorized Representative Form
Change Your PCP Form
Continuity of Care Form
Coordination of Benefits Form
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Direct Member Reimbursement - Standard
Direct Member Reimbursement Form - COVID Test
Electronic Funds Transfer Form
Explanation of Benefits Sample
Form 1095-B
Health Risk Assessment – Healthy Michigan Plan
Individual Change Form – McLaren Health Plan Off Exchange
Mail Order Pharmacy Order Form – Birdi
Medicaid and Healthy Michigan Plan New Member Survey
Medicaid COVID Test Direct Member Reimbursement
Member Enrollment and Change Form
MHP - Continuation of Coverage - Online Form
Non-Opioid Directive Form
PHI Revocation Form
Prescription Drug Reimbursement Form
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