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Member materials and forms

Here, you’ll find the info and forms you need to get the most from your plan.

Member materials

Member handbook – English (PDF)

Member handbook – Spanish (PDF)

Member handbook – Chinese (PDF)

Member handbook – Russian (PDF)

Member handbook – Haitian Creole (PDF)

Model handbook complaint and appeal 2023: plan info added (PDF)

Healthix flyer (PDF)

Healthix patient frequently asked questions (FAQs) (PDF)

Healthix Consent Form (PDF)

Healthix Consent Form (Spanish) (PDF)

Healthix Consent Form (Hindi) (PDF)

Healthix Consent Form (Haitian-Creole) (PDF)

Healthix Consent Form (Russian) (PDF)

Healthix Consent Form (Chinese) (PDF)

Forms

Advance directives – English (PDF)

Advance directives – Spanish (PDF)

Advance directives – Chinese (PDF)

Advance directives – Russian (PDF)

Advance directives – Haitian Creole (PDF)

Advance directives – Hindi (PDF)

Advance Directives - additional languages

Appointment of representative form

Fair hearing request form

Fraud, waste and abuse form

Model Handbook Complaint and Appeal 2023 plan info added (PDF)

Patient consent form – English (PDF)

Patient consent form – Spanish (PDF)

Patient consent form – Chinese (PDF)

Patient consent form – Russian (PDF)

Patient consent form – Haitian Creole (PDF)

Patient consent form – Hindi (PDF)