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Member Materials

Some of our Cal-MediConnect materials are online. To view and print them, you must have Adobe Acrobat Reader.  

Name English Español Tiếng Việt 中文 Tagalog
Advance Health Care Directive Form
Annual Notice of Changes (ANOC)
Annual Notice of Changes (ANOC) - 2020
Appointment of Representative (AOR)
Best Available Evidence - CMS Policy
Denti-Cal Provider List
Durable Medical Equipment (DME) List
Durable Medical Equipment (DME) List - 2020
Language Assistance Services
List of Covered Drugs (Formulary)
List of Covered Drugs (Formulary) - 2020
List of Drugs Requiring Prior Authorization
List of Drugs Requiring Prior Authorization - 2020
List of Drugs Requiring Step Therapy
List of Drugs Requiring Step Therapy - 2020
Medicare / Medi-Cal - Update your Information
Member Grievance Form
Member Handbook
Member Handbook - 2020
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
Provider and Pharmacy Directory - 2020
Quality Improvement Program Description
Request for Redetermination of Part D Drug Denial
Summary of Benefits
Summary of Benefits - 2020
Vision Service Plan (VSP) Doctor Directory