Member Handbook, Provider Directory, Preferred Drug List and Forms

Manuals

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

• Member Handbook (PDF) Hard copies of the handbook are available upon request after 7/1/2019.
• Provider Directory (PDF)
• Preferred Drug List

Forms

• Health Information Form (PDF) Coming Soon
• Notification of Pregnancy (NOP) Form (PDF)
• PCP Change Form (PDF)
• Grievance/Appeal Form (PDF)
• 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 1-833-404-1061 (TTY: 711).

Once you have completed your request, the paper format item(s) will be mailed within 5 business days from the date of the request.