01. Edit your form online
Type text, add images, blackout confidential details, add comments, highlights and more.
Questionnaire - Harvard Pilgrim Health Care 2026
Here's how it works
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out Questionnaire - Harvard Pilgrim Health Care with our platform
Ease of Setup
DocHub User Ratings on G2
Ease of Use
DocHub User Ratings on G2
- Click ‘Get Form’ to open the Questionnaire - Harvard Pilgrim Health Care in the editor.
- Begin by entering your Member Name, HPHC ID, and Date of Service at the top of the form.
- Indicate if the injury/illness was related to an Auto/Motorcycle Accident, Work/Industrial Accident, or No Accident by checking the appropriate box.
- If applicable, fill out Sections 1, 2, and 4 for Auto/Motorcycle related incidents or Sections 1, 3, and 4 for Workers' Compensation claims. If there is no other party liable, check 'No Accident' and complete Section 1.
- In Section 1, provide details about the date and location of the injury/illness along with a brief description of how it occurred. Answer whether you are still being treated for this injury.
- For Section 2, if applicable, specify your role in the accident (Pedestrian, Passenger, Driver) and provide insurance information as required.
- Complete Section 3 if this was a Work/Industrial Accident by providing employer details and any Workers’ Compensation claim information.
- Finally, in Section 4, indicate if you are represented by an attorney and provide their contact information. Sign and date the form before submission.
Start filling out your Questionnaire - Harvard Pilgrim Health Care today using our platform for free!
Is Harvard Pilgrim health good?
Harvard Pilgrim Health Care, now part of Point32Health following its merger with Tufts Health Plan, remains a leading nonprofit insurer in New England. As of 2026, it offers a mix of under-65 and Medicare options in Massachusetts, Maine, New Hampshire, and other Northeast states.
Is Harvard Pilgrim Health Care UnitedHealthcare?
Point32Health, Inc. Harvard Pilgrim Health Care / Parent organization
What is HCHP?
The Harris Health Health Care for the Homeless Program (HCHP) overcomes obstacles faced by persons experiencing homelessness by providing patient-centered health care utilizing a service delivery model that provides care through shelter-based clinics and mobile units.
Are Harvard Pilgrim and UnitedHealthcare the same?
Provider coverage includes Harvard Pilgrims network in five New England states, and our national network partner, UnitedHealthcare for the remaining states. In addition to the Harvard Pilgrim and UnitedHealthcare networks, members may see an out-of-network provider, at a higher cost.
What happened to Harvard Pilgrim Health Care?
As you may have heard, Tufts Health Plan and Harvard Pilgrim Health Care have recently completed a merger. Please find additional information and resources regarding the merger below: Tufts Health Plan and Harvard Pilgrim Health Care are now part of one combined organization.
Security and compliance
At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.
People also ask
What company owns Harvard Pilgrim?
Our enterprise comprises UnitedHealth Group, Optum and UnitedHealthcare. In addition to these core organizations, were powered by our affiliates who operate on a physician-centered model.
Related links
Understand medical conditions, tests, and treatment options; Take a personal Health Questionnaire on the Harvard Pilgrim secure website; Access your PersonalRead more
5. Mail completed claim form and all attachments to the following address: Harvard Pilgrim Health Care. P.O. Box 699183. Quincy, MA 02269. Any missing orRead more