2021 Member Forms

Enrollment Forms:

Medical benefits:

Pharmacy benefits (including Part D vaccines):

Dental Reimbursement form:

Prescription Drug Forms:

Billing Form:

Representative Forms:

Privacy Form:

New Member Presentations:

Harvard Pilgrim is an HMO/HMO-POS plan with a Medicare contract. Enrollment in StrideSM (HMO) depends on contract renewal.

Links on this page may take you away from the Harvard Pilgrim Health Care website.

Y0098_21111                                                         Last Update: 06/29/2021