Member resources
Individual & Family Member Resources
Access the tools and resources you need to manage your Individual & Family health plan. Find plan documents, member forms, provider directories, prescription drug information, and other helpful resources - all in one convenient place.
General Plan Information
- 2026 Pediatric Dental/Vision
- 2026 Adult Dental/Vision
- Transparency in Coverage
- Fight Healthcare Fraud
- Your Rights and Protections Against Surprise Medical Bills
- Interoperability - "How to guide"
- Non-Discrimination Notice
- Notice of Language Availability
- Mental Health and Substance Use Disorder Benefits.
- Member Rights and Responsibilities
- Click here for tips on staying healthy and managing certain health conditions.
Plan Year Information
- Member Portal I Create an account
- Companion Guide, English | Spanish
Formulary/Drug List.
- Online Search
- Printable Formulary, English | Spanish
- Prior Authorization Criteria
- Pharmacy Prior Authorization Form
Forms & Plan Documents.
- Application, English | Spanish
- Change/Termination Form, English | Spanish
- Authorized Representative, English | Spanish
- SEP Attestation, English | Spanish
- Medical Reimbursement Form, English I Spanish
- Prescription Drug Reimbursement Form
- Premium Payment Options, English | Spanish
- Autopay, English | Spanish
- Summary of Benefits and Coverage (SBCs)
- Schedule of Benefits (SOBs)
- Continuity of Care/Transition of Care Request Form, English l Spanish
- Understanding Transition of Care
- Understanding Continuity of Care
- Medical Prior Authorization List
- Medical Prior Authorization List Changes
- Medical Drug Prior Authorization List
Participating Providers
- Online directory
- Printable directory, English | Spanish - Updated April 3, 2026
- Dental providers - Select the specialty and your location. Under the "Network" dropdown, choose one of the below:
- For pediatric care, choose "Health First Health Plans - Individual Pediatric."
For adult care, choose "Health First Health Plans - Individual Adult/Family."
- Vision providers - English | Spanish (select "Find an eye doctor" | seleccione "Buscar un oftalmólogo.")
- Behavioral Health
- Pharmacy locations
Internal Medical Policies
- MOHS Micrographic Surgery (MP 0111)
- Orthognathic (Jaw) Surgery (MP 0135)
- Barostim (MP 0225)
- Bariatric Surgery (MP 0102)
- Breast Surgery (MP 0173)
- Bone Growth Stimulation (Osteogenic) (MP 0181)
- LINX™Reflux Management System (MP 0191)
- Surgical Treatment of Gastroesophageal Reflux Disease (GERD) (MP 0211)
- DaT Scan (MP 0222)
- Erectile Dysfunction (ED) Treatment (MP 0112)
- Home Births (MP 0171)
- Bronchial Thermoplasty (MP 0187)
- Autologous Condrocyte Implants (MP 0189)
- Drug Testing in Pain Management and Substance Abuse Treatment (MP 0192)
- Wearable Cardioverter Defibrillator (MP 0209)
- Cardiac Contractility Modulation (CCM) Therapy - Optimizer® Device (MP 0224)
- Hypoglossal Nerve Stimulation Implant (Inspire TM ) (MP 0230)
- Vulvectomy (MP 0215)
- Pharmacogenetic Testing Policy (MP 0226)
- Genetic Testing for Hereditary (MP 0227)
- Genetic Testing for Screening Diagnosis, Treatment, & Monitoring of Cancer (MP 0223)
- Prophylactic Surgery (MP 0228)
- Chimeric Antigen Receptor (CAR) T-cell therapy (MP 0231)
- Bioengineered Skin and Soft Tissue Substitute (MP 0196)
- Vivostim (MP 0238)
- Continuous Glucose Monitoring (CGM) (MP 101)
- Gender Affirmation Surgery (MP 0193)
- Routine Costs Associated with Clinical Trials (MP 0236)
- Genetic Testing Minimal Residual Disease (MRD) Testing for Cancer Policy PAC (MP 0237)
- Radiological Superficial Treatment of Nonmelanoma Skin Cancer (MP 0239)
- Outpatient Surgical Procedures Site of Service (MP 0240)
- Solid Organ Transplant Adult Liver (MP-0241)
- Heart Transplant (MP 0242)
- Hypoglossal Stimulation (Inspire®) (MP 0230)
- DaT scan (MP 0222)
- Appropriate Professionals Procedure
- Appropriate Professionals Policy
- Clinical Criteria for Utilization Management (UM) Decision Making Procedure
- Clinical Criteria for Utilization Management (UM) Decision Making Policy
- Medical Policy Administration Policy
- Medical Policy Administration Procedure
- Click here for a list of tips on staying healthy and managing health conditions.
- Check the guidelines here.
- Check the guidelines here.
Last Updated: 6/28/2026