Documents

Mail order, automatic payment and claims documents

Coverage decision, redetermination and exception documents

Appointing a representative and confidential information documents

  • Appoint a representative
    You can choose someone to file grievances, request coverage decisions and redeterminations on your behalf.
  • Authorization to release information
    You can give us permission to give your protected health information (PHI) to a person or organization on your behalf.
  • Confidential communication request
    You can request to have member communications, including claims-related information, mailed to a different address than your permanent address.
  • Our privacy practices
    Learn how information about you may be used and disclosed and how you can get access to this information.