Skip to main content

Member materials and forms

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

Member materials

Member handbook ― English (PDF) | Spanish (PDF)

Member quick guide ― English (PDF) | Spanish (PDF)

Member waiver handbook (PDF)

Member Communication January 2023 (PDF)

Services requiring prior authorization

Forms

Change of address

Appeal and grievance form

Fraud and abuse form

Authorized representative — English (PDF) | Spanish (PDF)

Advanced directive — English (PDF) | Spanish (PDF)

Notification of pregnancy (PDF)

FamilyCare Central ROI form — English (PDF) | Spanish (PDF)

Authorization to release protected health information (PHI) - English (PDF) | Spanish (PDF)