Prior Approval Request Form

Authorization of Personal Representative Form

If you would like to authorize someone else to call HNE and discuss your information, complete and sign the form and send it to the HNE Enrollment Department at One Monarch Place, Springfield, MA 01144. (Please note: the authorization is valid only if signed.) You may revoke the authorization at any time by sending a letter to us at the same address. For more details, see also our Notice of Privacy Practices.

HNE Personal Health Record

HNE Weight Watchers® Reimbursement Program and the
HNE Fitness Promotion
Not all groups offer this discount.  Please check your membership materials, or contact HNE Member Services if you need more information.
Download a reimbursement form.

Outpatient MH/SA Treatment Request Form

Pharmacy Forms