Member Guide and Materials

Some forms are in Adobe Portable Document Format (PDF) and may be viewed with the free Adobe Acrobat Reader. If you do not have Acrobat Reader, you may download from Adobe.

Appeal / Grievance Process (PDF 21K)
Health Information Release Consent Form (PDF 82K)
Notice of our Information Privacy Policies and Practices (PDF 66K)
Prescription Reimbursement Form (PDF 243K)
Member Handbooks
- 2008 Healthy Options Medical Benefits (PDF 3.1M)
- 2008 Basic Health Medical Benefits (PDF 2.2M)
- 2008 Basic Health/Healthy Options Provider/Pharmacy Directory (PDF 613K)
2007 Prior Authorization Criteria (PDF 314K)
2008 Prior Authorization List (PDF, 62K)
2008 Routine Care and Screening Guidelines (PDF 1.5M)
2008 Disease Management Guidelines (PDF 1.0M)
Member Rights and Responsibilities
Authorization for Release of Protected Health Information (PDF 56K)
Protected Health Information Restriction Request Form (PDF 32K)

GA-U

Appeal / Grievance Process (PDF 23K)
Mandatory Managed Care Program (PDF 26K)
GAU Sign-Up Form (PDF 45K)
Member Handbook (PDF 2.1M)
Provider/Pharmacy Listing (PDF 1.3M)