Member Handbook, Manuals and Forms

Member Handbook, Provider Directory, Preferred Drug List and Forms

Manuals

Here are links to the manuals and forms available to you.

• Member Handbook (PDF)
• Provider Directory (PDF)
• Preferred Drug List (PDF)

Forms

• My Health Risk Screening
• Notification of Pregnancy (NOP) Form (PDF) 
  • NOP can be mailed to:

• PCP Change Form
• Grievance/Appeal Form (PDF)- Coming Soon
• Authorized Representative Designation Form (PDF)

Any documents and items offered in electronic format can be requested in paper format. To request a document in paper format, please contact Member Services at 1-833-752-1665 (TTY: 711).

Once you have completed your request, the paper format item(s) will be mailed within 10 business days from the date of the request.