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Farm Bureau Health Plans

Forms & Resources

This page is a one-stop shop for all things related to Farm Bureau Health Plans forms. You can download and print applications, prescription claims forms, change of coverage forms and more.

Get Started With An Application

2021 Medicare Supplement
Download
Medicare Supplement
Download
DentalVision Silver
Download
Dental Care
Download
Enhanced Choice
Download
Core Choice
Download
Major Medical
Download
High Deductible Health Plan
Download
Short-Term Coverage
Download
DentalVision
Download
Individual & Family Grandfathered
Download

Forms Used with a New Application

Medical Request form (Age 0-2 Months)
Download
Medical Request Form (Age 3-25 Months)
Download
Medical Request Form (Age 40 and Older)
Download
Request for Medical Records
Download

Claims Forms

Individual & Family Coverage Claim Form
Download
Medicare Supplement Coverage Claim Form
Download
Individual & Family Prescription Claim Form
Download
Medicare Supplement Prescription Claim Form
Download
Prescription Drug Claim Form for Mail Order
Download
Secondary Insurance Form
Download

Other Useful Forms

Grievance Procedure
Download
Grievance Form
Download
Notice of Privacy Practices
Download
TFBF Membership Application and Agreement
Download
Personal Representative Designation Form
Download
General Bank Draft Authorization Form
Download
Medicare Supplement Bank Draft Authorization Form
Download
Alternative Plan Selection Change Transfer Form
Download
Cancellation Form
Download
Request for Reconsideration of Benefit Exclusion Rider
Download
Request for Reconsideration of Declined Coverage
Download
Request for Reconsideration of Rate
Download
Request for Reconsideration of Tobacco Rate
Download
Medicare Supplement Plan Selection Form
Download
Medicare Supplement Plan Change Form
Download

Visit a Farm Bureau Office

There are 195+ offices throughout Tennessee, so stop by and see us.

For More Information, call

1-877-874-8323