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Materiales para miembros
- Integrative health services member handbook ― English (PDF)
- Integrative health services member handbook ― Spanish (PDF)
- Mental health and substance use treatment services handbook ― English (PDF)
- Mental health and substance use treatment services handbook ― Spanish (PDF)
- Provider and pharmacy directory (PDF)
- Clinical Practice Guidelines (PDF)
Formularios
- Submit a Grievance (PDF)
- Member Appeal Form (PDF)
- Authorization to release protected health information (PHI) (PDF)
- Authorization to release psychotherapy notes (PDF)
- Fraud, waste and abuse form
- Grievance and appeal form
- 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
- 2025 Value Added Benefits (PDF)
- Q3 EAC Meeting Minutes (PDF)