This page is a one-stop shop to all things related to forms associated with Farm Bureau Health Plans for individuals and families. You can download and print prescription claims forms, change of coverage forms and more.
Forms and Resources for Individuals and Families
Forms and Resources for Individuals and Families
Most providers will file health care claims for you. However, should you need to file a claim, please complete this form.
Use this form to request reimbursement for covered medications purchased at retail cost.
This document is intended to help you quickly compare coverage benefits and is a summary of in-network benefits only.
This document is intended to help you quickly compare coverage benefits and is a summary of in-network benefits only.
This document is intended to be a summary of benefits for all Farm Bureau Health Plans. Use it to help you understand what is best for you.
This document is intended to be a summary of benefits for all Farm Bureau Health Plans. Use it to help you understand what is best for you.
This is a request form for any type of medical records that need to be requested for adults aged 40 or older
This is a request form for any type of medical records that need to be requested for children 3-25 months old.
This is a request form for any type of medical records that need to be requested for newborns through two months of age.
If you need to change your bank information for your monthly premium payment, please complete this form, attach a voided check and mail both to Ohio Farm Bureau Health Plans.
Please complete this form if cancelling your coverage with Ohio Farm Bureau Health Plans.
This form allows you to make changes to your current coverage.
This form allows an employer to let Ohio Farm Bureau Health Plans know an employee/client no longer works for them and the client will take over the health plan payment.
Your completion of this form allows you to designate someone as your personal representative on your Ohio Farm Bureau Health Plans coverage.
This resource explains the grievance procedure used by Ohio Farm Bureau Health Plans.
Use this form if you would like to file a grievance, after you've read the grievance procedure.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.