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School of Medicine
|Enrollment application form. This PDF form allows you to type directly onto it before printing. All other forms (below) must be printed first and then hand written.||Johns Hopkins US Family Health Plan application form|
|Allotment Authorization form|
|Automatic Payment form|
Johns Hopkins US Family Health Plan Authorization for use and disclosure of Protected Health Information (PHI).
|Member Reimbursement: If you are ever required to pay a provider use this form, along with a copy of your receipt for full reimbursement. PLEASE NOTE: For Pharmacy reimbursement claims, please use form below.|
|Pharmacy: Home delivery is available for up to a 90-day supply of approved medications through Rite Aid at Wyman Park. Home delivery is best suited for medications you take on a regular basis.|
|Pharmacy: Brand-name drugs with a generic equivalent may be dispensed only if your physician submits a medical necessity request and approval is granted by USFHP.|
|Pharmacy: In the event that you fill a prescription at a non-network pharmacy due to an emergent situation, you may seek reimbursement for incurred cost|