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Member materials and forms

Here, you’ll find the info and forms you need to get the most from your plan.

Member materials

Member handbook (PDF)

Certificate of coverage (PDF)

Advance directive FAQs (PDF)

Forms

Authorization to release protected health information (PHI) (PDF)

Authorization to release psychotherapy notes (PDF)

Patient advocate designation (PDF)

Health risk assessment (PDF)

Fraud, waste and abuse form

Removal of Previous Auth — English (PDF) | Spanish (PDF)

Request for Accounting of Disclosures of PHI GR-69239-5 — English (PDF) | Spanish (PDF)

Auth to Release PHI GR-69126-5 — English (PDF) | Spanish (PDF)

Auth to Release Psychotherapy Notes GR-69127-5 — English (PDF) | Spanish (PDF)

PHI Access Request GR-69238-5 — English (PDF) | Spanish (PDF)