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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 


Medallion (Medicaid)/FAMIS Member handbook ― English (PDF) | Spanish (PDF)


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


Member Vaccine Incentive Letter Form ― English (PDF) | Spanish (PDF)


Diabetes wellness exam flyer ― English (PDF) | Spanish (PDF)


Transitioning from Pediatrics to Primary Care Flyer ― English (PDF) | Spanish (PDF)


Well Woman Exams Flyer ― English (PDF) | Spanish (PDF)


Men's Health Exams Flyer ― English (PDF) | Spanish (PDF)


EPSDT Member Tip Sheet: Birth to 3 years ― English (PDF) | Spanish (PDF)


EPSDT Member Tip Sheet: Ages 3 to 21 years ― English (PDF) | Spanish (PDF)



Nursing facility transition brochure (PDF)


Maternity Incentive Program form ― English (PDF) | Spanish (PDF)


Important information regarding PPL (Public Partnerships, LLC) (PDF)


Member reimbursement request form for non-traditional Indian medicine (PDF)


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


Authorization to release psychotherapy notes ― English (PDF) | Spanish (PDF)


Fraud, waste and abuse form

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