Forms

At Saint Mary’s Health Plans, our goal is to make our health plans easy to understand and our coverage easy to access. We strive to be responsive to each member's needs and we are committed to helping you get all you need from your health plan quickly, efficiently and conveniently. Below are links to a variety of downloadable forms needed to access your health care:

• Member Claim Form (PDF)
• Catalyst Rx Member Reimbursement Form (PDF)
• Disclosure of Health Information Form (English) (PDF)
• Disclosure of Health Information Form (Spanish) (PDF)
  
  
• Catalyst Mail Mail-Order Form (PDF)
• Catalyst Mail Health, Allergy & Medication Questionnaire (PDF)
  

For a Travel Reimbursement form for tertiary care received at network facilities in Utah, contact SMHP Medical Management at 775.770.6211. For more information about Travel Reimbursement, click here.