Forms & Resources
This page is a one-stop shop for all things related to Farm Bureau Health Plans forms. You can download and print applications, prescription claims forms, change of coverage forms and more.
Get Started With An Application
Medicare Supplement
DentalVision Silver
Dental Care
Enhanced Choice
Core Choice
Major Medical
High Deductible Health Plan
Short-Term Coverage
DentalVision
Individual & Family Grandfathered
Forms Used with a New Application
Medical Request form (Age 0-2 Months)
Medical Request Form (Age 3-25 Months)
Medical Request Form (Age 40 and Older)
Request for Medical Records
Claims Forms
Individual & Family Coverage Claim Form
Medicare Supplement Coverage Claim Form
Individual & Family Prescription Claim Form
Medicare Supplement Prescription Claim Form
Prescription Drug Claim Form for Mail Order
Secondary Insurance Form
Over-the-counter (OTC) at-home COVID-19 test kit reimbursement form
Other Useful Forms
Grievance Procedure
Grievance Form
Notice of Privacy Practices
TFBF Membership Application and Agreement
Personal Representative Designation Form With Instructions (U65)
General Bank Draft Authorization Form
Medicare Supplement Bank Draft Authorization Form
Alternative Plan Selection Change Transfer Form
Cancellation Form
Request for Reconsideration of Benefit Exclusion Rider
Request for Reconsideration of Declined Coverage
Request for Reconsideration of Rate
Request for Reconsideration of Tobacco Rate
Medicare Supplement Plan Selection Form
Medicare Supplement Plan Change Form
Personal Representative Designation Form With Instructions (O65 Med Supp)
Right to Access Request
Request For An Accounting Of Disclosures
HIPAA Authorization For Release Of Protected Health Information
Privacy Complaint
Restriction Request
Amendment Request
Alternative Communications Request
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