Documents & Forms Center

Members

General Pregnancy Information

PDF icon General Pregnancy Information.pdf

Agents, Employers, Members

Getting Care In A Disaster Area

PDF icon Getting Care In A Disaster Area.pdf

Agents, Employers, Members, Providers

Glossary of Health Coverage and Medical Terms

PDF icon Glossary of Health Coverage and Medical Terms.pdf

Agents, Employers, Medicare, Members, Providers

Health and Fitness Reimbursement Form

PDF icon Fitness Reimbursement Form 040820 FILLABLE.pdf

Members

Healthline Newsletter Fall 2023

PDF icon 23-CHP-029 Healthline Newsletter Fall 2023-V3_3.pdf

Members

Healthline Newsletter February 2023

PDF icon 23-CHP-002-Healthline-Newsletter-Update-DIGITAL-V2-2.pdf

Members

Healthline Newsletter February 2023

PDF icon 23-CHP-002-Healthline-Newsletter-Update-DIGITAL-V2-2.pdf

Members

Healthline Newsletter February 2023

PDF icon 23-CHP-002-Healthline-Newsletter-Update-DIGITAL-V2-2.pdf

Agents, Members, Providers

J Code Med only update website 07 24

Agents, Employers, Members

LabCorp Frequently Asked Questions

PDF icon LabCorp FAQs.pdf

Agents, Employers, Members

LabCorp Locations

PDF icon LabCorp Locations.pdf

Members

Large Employer Member Handbook - Effective 10-1-2021+

PDF icon Large Employer Member Handbook - Effective 10-1-2021 Forward.pdf

Members

Large Employer Member Handbook - Effective 10-1-2021+

PDF icon Large Employer Member Handbook - Effective 10-1-2021 Forward.pdf

Members

LARGE EMPLOYER MEMBER HANDBOOK - EFFECTIVE 10-1-2022+

PDF icon 2022.06.LgMbrHb.pdf

Members, Providers

Medical Services That Require Prior Auth

PDF icon MEDICAL-SERVICES-THAT-REQUIRE-PRIOR-AUTHORIZATION-1-31-23.pdf

Medicare, Members

Medicare Prescription Drug Reimbursement Request

PDF icon MCR Prescription Drug Request for Reimbursement.pdf

Agents, Employers, Members

Member Status Change Form

PDF icon Member Status Change Form 2020.pdf

Members

Non- Group Conversion (NGC-B) $15/$30/$50

PDF icon Non-GroupConversionNGC-B01-01-21.pdf

Members

Non-Group Conversion

PDF icon Non-Group Conversion.pdf

Members

Non-Medicare Appointment of Representation Form

PDF icon COM AOR form_3.11.15.pdf

Agents, Employers, Members

Non-Medicare Prescription Drug Reimbursement Request

PDF icon Non-Medicare Prescription Drug Reimbursement Request _ 2022 Updated.pdf

Members

Parental Consent for Care of Minor Children

PDF icon Parental-Consent-for-Minor-Children_CHP-41.pdf

Members

Patient Health Questionnaire

PDF icon Patient Health Questionnaire (PHQ-9).pdf

Agents, Employers, Members

Pregnancy And Coverage FAQ

PDF icon Pregnancy And Coverage FAQ.pdf