2022 Member Forms

Enrollment Forms:

COVID-19 (at home tests coverage):

Medical benefits:

Pharmacy benefits (including Part D vaccines):

Dental Reimbursement form:

Prescription Drug Forms:

Billing Form:

Representative Forms:

Privacy Form:

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.

H6750_22139                                                        Last Update: 11/8/2022