Below you will find forms, downloads, and other resources that you may find useful.
Plan Central Access Request Form – submit this form to request access to PlanCentral.
Transitional Care Online Form – To assist with transition to the new health plan, members and dependents need to complete the Transitional Care form so a smooth arrangement of your medical care to CrestPoint Health can be achieved.
If you would prefer to send this by mail, download and print the PDF version, otherwise, use the simple online form.
Coordination of Benefits Online Form – Your health plan, administered by CrestPoint Health, contains a coordination of benefits (COB) provision which applies to situations where there may be overlapping coverage. To ensure accurate processing of claims without COB delays, please complete the COB form and return it to the address listed on the form.
If you would prefer to send this by mail, download and print the PDF version, otherwise, use the simple online form.
Prior-Authorization Request Form(pdf) – CrestPoint Health requires prior authorization for elective hospital admissions and certain acute outpatient services. Prior authorization is not required for emergency services. Print this form and complete as the cover sheet to submit appropriate clinical information for a prior authorization request and send to fax number 330-996-1910.
Mail in Pharmacy – Learn more about MedVantx or download the MedVantx order form
Accessing Your Vision Care Discount – Learn more about accessing your vision care discount.
Members Rights – As a member of CrestPoint Health, you have the following Member Rights and Responsibilities. This Statement of Member Rights and Responsibilities was created to outline what you can expect from your health care and how you can improve it too.
