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Member Materials

Forms, notices, member handbooks and more for your reference

IEHP DualChoice

Learn about any changes to your IEHP DualChoice plan for the current year.

IEHP DualChoice Annual Notice of Changes (Updated 10/1/2025)

 

 

Appoint a trusted person to act as your representative for IEHP DualChoice services.

IEHP DualChoice Appointment of Representative Form (PDF)

 

Find everything you need to know about your IEHP DualChoice plan.

IEHP DualChoice Member Handbook (PDF) (Updated 02/05/2026)



 

Learn about all your IEHP DualChoice benefits.

IEHP DualChoice Summary of Benefits (PDF) (Updated 10/1/2025)

 

 

 

IEHP DualChoice Provider Directory
Choose the right providers for you who accept IEHP DualChoice.

 

IEHP DualChoice Formularies

Find info about which prescription drugs IEHP DualChoice covers:

 

Here’s everything else you may need as an IEHP DualChoice member.

More Information

 

File a grievance through the mail.
File a grievance

    Medi-Cal

    Learn everything you need to know about your Medi-Cal plan.

     

    Medi-Cal Provider Directory


    Choose the right providers for you who accept Medi-Cal.

     

    Find out how you can file an appeal.

    Medi-Cal Member Appeals Resolution Process

     

    Here’s everything else you may need as a Medi-Cal member.

    More Information

     

    File a grievance through the mail.

    File a grievance

      IEHP Covered California

      Choose the right providers for you who accept IEHP Covered.

      IEHP Covered Provider Directory (Updated 01/30/2026)

       

      Find everything you need to know about your IEHP Covered plan, including benefits and your out-of-pocket costs.

      Evidence of Coverage

       

      Find info about which prescription drugs IEHP Covered covers.



       

      Here’s everything else you may need as an IEHP Covered member.

      Other Benefit Information

      File a grievance through the mail.

      File a grievance

        IEHP Forms

        Appoint a trusted person to act as your representative for selected IEHP services.

        Appointment of Representative Form

         

        Update your contact info for receiving communications about your medical information.

        IEHP Confidential Communication Request (CCR)

         

        Request protected health information records (PHI). 

        IEHP Authorization for Use and Disclosure of Protected Health Information

         

        File a grievance.

        Grievance Form

         

         

         

          IEHP DualChoice (HMP D-SNP) is an HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) depends on contract renewal.

          Information on this page is current as of October 1, 2025.

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