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Materiales para miembros
Integrative health services member handbook ― English (PDF) | Spanish (PDF)
Mental health and substance use treatment services handbook ― English (PDF) | Spanish (PDF)
Provider and pharmacy directory (PDF)
Formularios
Authorization to release protected health information (PHI) (PDF)
Authorization to release psychotherapy notes (PDF)
Member advisory committee application ― English (PDF) | Spanish (PDF)
Notification of pregnancy (PDF)
Transition of care form ― English (PDF) | Spanish (PDF)
Notice of Privacy Practices ― English (PDF) | Spanish (PDF)
Protected health information (PHI) access request form GR-69238-1 — English | Spanish
Request for an Accounting of Disclosures of Protected Health Information (PHI) GR-69239-1 — English | Spanish
Protected health information (PHI) release form GR-69126-1 — English | Spanish
Authorization to release psychotherapy notes GR-69127-1 — English | Spanish
Removal of Authorization Previously Given to Aetna GR-69240-1 — English | Spanish
2024 Value Added Benefits (PDF)