Welcome to Health Plan of Nevada! Your health is important to us. That’s why we need a little more information to help provide you and your family with quality care to meet your medical needs. Please take a few minutes to fill out this form. Each adult in the home needs to complete their own form. Your answers are confidential and will only be used to assist you and your family with medical care. If you need help filling out this form, call us toll-free at 1-800-962-8074, TTY 711, Monday through Friday, 8 a.m. to 6 p.m. If we have any questions, we may reach out to you.
You may also choose to download a PDF version of the form to be filled out and mailed in.
Fraud, Waste and Abuse Information (FWA)
Language Assistance/Non-Discrimination Notice
Members' Rights and Responsibilities
Behavioral Healthcare Options
Health Plan of Nevada