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Member Materials

Forms, notices, member handbooks and more for your reference

IEHP DualChoice

IEHP DualChoice Annual Notice of Changes
Learn about any changes to your IEHP DualChoice plan for the current year.

 

IEHP DualChoice Appointment of Representative Form
Appoint a trusted person to act as your representative for IEHP DualChoice services.

 

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

 

IEHP DualChoice Summary of Benefits
Learn about all your IEHP DualChoice benefits.

 

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:

 

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

    Medi-Cal

    Medi-Cal Member Handbook and Evidence of Coverage
    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.

     

    Medi-Cal Member Appeals Resolution Process
    Find out how you can file an appeal.

     

    More Information

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

      IEHP Covered California

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

       

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

       

      IEHP Covered California Formulary
      Find info about which prescription drugs IEHP Covered covers.

       

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

        IEHP Forms

        Appointment of Representative Form
        Appoint a trusted person to act as your representative for selected IEHP services.

         

        IEHP Confidential Communication Request (CCR)
        Update your contact info for receiving communications about your medical information.

         

        IEHP Authorization for Use and Disclosure of Protected Health Information
        Request protected health information records.

         

        Grievance Form
        File a grievance.

         

        IEHP Covered Grievance Form Print Out
        File a grievance through the mail.