Member Handbooks and Forms
Attention Members! If you are interested in having a printed copy of the Member Handbook, just contact Customer Service at 844-366-2880. You'll receive the free printed handbook in about five business days after your request.
- 2025 Member Handbook - English (PDF)
- 2024 REVISED Member Handbook - English (PDF)
- 2023 Member Handbook - English (PDF)
- 2022 Member Handbook - English (PDF)
- 2021 Member Handbook - English (PDF))
- 2020 Member Handbook - English (PDF)
- Disenrollment Update (PDF)
- Notification Of Pregnancy Form (PDF)
- General Health Risk Screening Form (PDF)
- Request to Change Primary Care Physician Form English(PDF)
- Request to Change Primary Care Physician Form Spanish (PDF)
- Health Information Form (PDF)
- Authorized Representative Designation Form (PDF)
- Revocation of Authorization to Use and/or Disclose Health Information (PDF)
- Authorization to Use and Disclose Health Information (PDF)
- SSHP In Network Facilities Notification
- Managed Care Organization (MCO) Change Form (PDF)