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.
As of Beginning November 1, 2008, Walgreens Pharmacy is no longer included in the Community Health Plan Pharmacy Network. This means that Community Health Plan will not pay for prescriptions filled at Walgreens on or after November 1, 2008.
To view alternative pharmacies in the Healthy Options, SCHIP, Basic Health, or GA-U network, look at the current list of pharmacies:
- Open or download the list (updated monthly) of participating Basic Health and Healthy Options pharmacies and participating GA-U pharmacies.
- Contact the Community Health Plan customer service team at 1-800-440-1561 (toll free). If you are hearing or speech impaired, please call TTY 1-866-816-2479 (toll free) or local 206-613-8875.
- Appeal / Grievance Process (PDF 21K)
- Health Information Release Consent Form (PDF 82K)
- Appeal Consent Form (PDF 29K)
- Notice of our Information Privacy Policies and Practices
- Prescription Reimbursement Form (PDF 243K)
- Member Handbooks
- 2009 Healthy Options Medical Benefits (PDF 3.1M)
- 2009 Basic Health Medical Benefits (PDF 2.2M)
- 2009 Basic Health/Healthy Options Provider/Pharmacy Directory (PDF 613K)
- 2007 Prior Authorization Criteria (PDF 314K)
- 2009 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)
- 2009 GA-U Member Handbook (PDF 2.1M)
- 2009 GA-U Provider/Pharmacy Listing (PDF 1.3M)
