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Member Materials

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Advance Health Care Directive Form
Annual Notice of Changes (ANOC)
Appointment of Representative (AOR)
Best Available Evidence - CMS Policy
Denti-Cal Provider List
Durable Medical Equipment (DME) List
Language Assistance Services
List of Covered Drugs (Formulary)
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Step Therapy
Medicare / Medi-Cal - Update your Information
Member Grievance Form
Member Handbook
Member Rights and Responsibilities
Notice of Nondiscrimination
Notice of Privacy Practices
Part D Coverage Determination Request
Part D Prescription Drug Claim Form
Personal Medication List
Provider and Pharmacy Directory
Quality Improvement Program Description
Request for Redetermination of Part D Drug Denial
Summary of Benefits
Vision Service Plan (VSP) Doctor Directory