Manuals and forms

Enrollment forms

Complete the enrollment forms below on your computer before you print. Simply download the pdf, and type in the appropriate information. Then print the completed form, sign and mail to the address indicated on the form.

Member Enrollment Form This form is used to add new members to an HMO or POS group policy.

Member Change Form This form is used to make changes to an existing member’s coverage, to add or remove dependents, to change demographic information and to cancel coverage.

Referral and Prior Authorization requests

When referred for services with a provider who is not within Health Tradition Heath Plan’s network, prior authorization from Health Tradition Health Plan may be required. Mayo Clinic in Rochester, Minnesota is considered an out-of-network provider. Additionally, some services require prior authorization even if obtained from an in-network provider. Health Tradition Health Plan members are encouraged to contact Customer Service with questions pertaining to referral or prior authorization.