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 for the 2008 Plan Year

Positive Healthcare Partners Abridged Formulary

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

Low Income Subsidy ("Extra Help") Best Available Evidence Policy

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.

You may request printed copies of the above forms and booklets by contacting our Members Services department at:

(888) 456-4715, TTY/TDD 711
Monday - Friday, 8 am - 8 pm EST