Member materials and forms

Member materials 

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

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

A woman's guide to health screenings ― Medallion (Medicaid)/FAMIS (PDF) | CCC Plus (PDF)

A man's guide to health screenings ― Medallion (Medicaid)/FAMIS (PDF) | CCC Plus (PDF)

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

Forms 

CCC Plus wellness rewards flyer ― English (PDF) | Spanish (PDF)

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

Medallion (Medicaid) well woman flyer ― English (PDF) | Spanish (PDF)

Nursing facility transition brochure (PDF)

CCC Plus wellness rewards flyer (PDF)

Diabetes wellness exam flyer (PDF)

Medallion (Medicaid) well woman flyer (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