Member Resources and Forms

Below are helpful resources and information related to your plan coverage. The documents listed below are in PDF format. You will need Adobe Acrobat Reader to view these documents.

BOOKLETS AND DIRECTORIES

Positive Healthcare Partners Evidence of Coverage 2008 (Standard Plan)

Positive Healthcare Partners Evidence of Coverage 2008 (Enhanced Alternative Plan)

Positive Healthcare Partners Abridged Formulary (Standard Plan)

Positive Healthcare Partners Abridged Formulary (Enhanced Alternative Plan)

Positive Healthcare Partners Pharmacy Directory (coming soon)

Positive Healthcare Partners Provider Directory

Positive Healthcare Partners Summary of Benefits

PHARMACY COVERAGE

Appeals and Grievances Information

Appointment of a Representative Information

Form CMS-1696 (Appointment of a Representative)

Coverage Determination Information

Medication Therapy Management Program Information

Prior Authorization Form / Drug Formulary Exception Form

MISCELLANEOUS FORMS

Individual Enrollment Form

You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above - the link will open a new window and take you to the Adobe website.