Get Forms and Documents

For your convenience here are templates you can download for necessary health plan forms. Simply download, open, and save a copy.

Prior Authorization Approval Form

Please submit a prior authorization form for any procedures you are planning to avoid balance billing. Most hospitals and doctors across the United States accept our coverage. If you have any questions about completing this form please call member services at 833-444-NOVA (6682).

Claims Inquiry Request Submission

For information about the status of your claim(s), please access the member portal and navigate to the claims folder located on the right-hand side of your dashboard.

Power of Attorney Form

(POA) or letter of attorney is a written permission to represent or work on behalf of someone in private, commercial, or other legal matter. The person authorizing the other person to act is (of power) the owner, grantor, or donor. The one allowed to act is the attorney-in-fact, the handler, the prosecutor, in certain common law jurisdictions.

Medical Expense Tracker

Before you meet your plan deductible, the amount you spend on services such as chiropractic care, massage therapy and acupuncture, even for items like vitamins and essential oils will count toward your deductible. Use this tool to keep track of your expenditures so that you can submit them within 30 days of the service or purchase date.

Multi State Fraud Warning

The fraud warnings listed  are applicable in the following states: AL, AK, AZ, AR, CA, CO, DE, DC, FL, HI, ID, IN, KY, LA, ME, MD, MA, MN, NE, NH, NJ, NM, NY, OH, 0K, OR, PA, TN, TX, W, VA, WA or VW. If you are located in one of these states, please take time to review the appropriate warning prior to submitting your claim.