Member Resources
Many of our member resources can be found on our secure portal. Click Login to create an account and access a wide array of resources! We’ve also provided a few resources below.
Member Handbook
Reference Materials
- Advance Directives
- Authorization to Disclose Health Information Form & Revocation of Authorization Form - English (PDF)
- Authorization to Disclose Health Information Form & Revocation of Authorization Form - Chinese (PDF)
- Authorization to Disclose Health Information Form & Revocation of Authorization Form - Russian (PDF)
- Authorization to Disclose Health Information Form & Revocation of Authorization Form - Vietnamese (PDF)
- Doctor's Office Visit Checklist (PDF) - Use this checklist to get prepared for your next doctor's appointment.
- Find a Provider Guide (PDF)
- Helpful Links
- Grievance and Appeal Process (PDF)
- List of Covered Preventive Services
- Member Rights & Responsibilites (PDF)
- My Health Pays & Gym Reimbursement (PDF)
- Notice of Privacy - English (PDF)
- Notice of Privacy - Spanish (PDF)
- Notice of Privacy - Chinese
- Notice of Privacy - Korean (PDF)
- Notice of Privacy - Russian (PDF)
- Notice of Privacy - Vietnamese (PDF)
- Preventive Services Guide (PDF)
- Quality Improvement (QI) Program
- Referral and Authorization Information
- Statement of Non-Discrimination
- Transparency Notice
- Where To Go For Care
- Women's Health and Cancer Rights Act Annual Notice
Forms
- Authorization to Disclose Health Information Form (PDF)
- Member Grievance and Appeal Form (PDF)
- Member Reimbursement Medical Claim Form (PDF) - Used to submit a paid claim for Out of Country emergency services received from an out-of-network international provider.
- Pharmacy Program Forms
- Prescription Claim Reimbursement Form (PDF)
- Transplant Reimbursement Form (PDF)