Member Handbook, Provider Directory, Preferred Drug List and Forms
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
- 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.