Get the forms and resources you need for things like Enrollment, HRA/FSA Reimbursement, Claims and more. You can easily find and download what you need to make sure your account stays up to date.
Alternative Plan Claim Form
Dental Claim Form
Employee Request for Participation
Health Plan Reimbursement Form
PHI Authorization Form
Complete form on your computer and print. Or, print and manually complete.
Send by mail or fax to 828-670-9155, ATTENTION: TPA
DO NOT email documents containing PHI from our website to protect your and your dependents’ privacy.
Crescent Health Solutions’ TPA staff will provide further notification as necessary.
Call 828-670-9145 or 800-707-7726 and select Option 3 to reach Benefits Administration, 8:30 am-5 pm EST.
These forms should only be used if Crescent Health Solutions is your Benefits Administrator. For any other claims payer, please refer to the contact information listed on your health plan ID card.
You should contact your Human Resources department to enroll in your employer’s health insurance or change your election within the allowable time due to a qualifying event (such as marriage, birth of a child, etc.).