Claims, Pre-Authorization, & Power of Attorney Forms

For your convenience, here are some templates you can download and use. Just download, open, and save.

Track all your medical expenses with our

Member expense Tracker

Before your deductible has been met, money spent on services, such as massage and acupuncture, and items like essential oils will count toward your deductible. Once your deductible has been met, you will be reimbursed for future wellness visits and supplements up to the maximum benefit allowance. It is important to note that not all supplements and essential oils are equal, nor will all of them be accepted. Check with your Personal Care Advocate to make sure the supplements and oils you wish to buy are approved prior to purchase. Remember that health and wellness service receipts, as well as the purchase of supplements, essential oils, etc. must be submitted within 30 days of service or purchase, and it is the member’s responsibility to validate that NOVA’s Claim Department has received those expense receipts. We will confirm via fax or email upon request. Member must request a confirmation via email by contacting claims@mynovahealthcare.org. 

Claims inquiry request form

Pre-Authorization Form

Please submit a Pre-Authorization for any Optional Procedures to avoid balance billing. Most hospitals and doctors across the U.S. will accept our plans.

A 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 matters. 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, only in certain common law jurisdictions.