Medicare Members: Protect yourself against Medicare fraud and Identify theft! The U.S. Department of Health and Human Services Office of Inspector General is alerting the public about a fraud scheme involving genetic testing. Learn how to protect yourself.
Additional Member Forms |
Additional Forms
Use this form when you want to allow us to share your health information with a person or group:
- PHI Authorization Form - English (PDF)
- PHI Authorization Form - Spanish (PDF)
- PHI Authorization Form - Chinese (PDF)
Use this form when you want us to cancel or revoke your previous permission to share health information with a person or group:
- PHI Revocation Form - English (PDF)
- PHI Revocation Form - Spanish (PDF)
- PHI Revocation Form - Chinese (PDF)
If you have questions please, contact Member Services.