Individual & Family Member Resources

• 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
• Authorized Representative Form
• Click here for tips on staying healthy and managing certain health conditions. 

Dental and Vision

• 2027 Pediatric Dental English I Spanish
• 2027 Adult Dental  English  I Spanish
• 2027 Pediatric Vision  English I Spanish
• 2027 Adult Vision  English I Spanish
   

Login to Our Member Portal

• Member Portal | Create an Account
• Companion Guide, English | Spanish 

Formulary/Drug List

• Online Search
• Printable Formulary, English | Spanish
• Autoimmune Criteria

Apply, Make Changes, or Terminate Plan Forms

• Off-Marketplace Application, English | Spanish
• SEP Attestation Form English, | Spanish
• Change/Termination Form, English | Spanish
• Marketplace Consent Form, English
• Authorized Representative, English | Spanish

Billing Forms

• Medical Reimbursement Form, English I Spanish
• Prescription Drug Reimbursement Form
• Premium Payment Options, English | Spanish
• Autopay, English | Spanish

Summary and Schedule of Benefits

• Summary of Benefits and Coverage (SBCs)
• Schedule of Benefits (SOBs)

Transition and Continuity of Care

• Continuity of Care/Transition of Care Request Form, English l Spanish
• Understanding Transition of Care
• Understanding Continuity of Care

Medical Drug Authorizations

• Commercial Medical Drug Step Therapy 
• Medical Drug Coverage Policy – General Policy 
• Medical Drug Coverage Policy – Specific Policies 
• Preferred Diabetic Testing Supplies 
• Medical Drug Prior Authorization List 
• Prior Drug Authorization Criteria
• Pharmacy Prior Authorization Form

Medical Prior Authorizations

• Medical Prior Authorization List 
• Medical Prior Authorization List Changes 
• Medical Prior Authorization Form

Dental and Vision

• 2026 Pediatric Dental/Vision
• 2026 Adult Dental/Vision
   

Login to Our Member Portal

• Member Portal | Create an Account
• Companion Guide, English | Spanish 

Formulary/Drug List

• Online Search
• Printable Formulary, English | Spanish
• Pharmacy online search I printable copy
• Autoimmune Criteria

Apply, Make Changes, or Terminate Plan Forms

• Application, English | Spanish
• Change/Termination Form, English | Spanish
• Authorized Representative, English | Spanish
• SEP Attestation, English | Spanish

Billing Forms

• Medical Reimbursement Form, English I Spanish
• Prescription Drug Reimbursement Form
• Premium Payment Options, English | Spanish
• Autopay, English | Spanish

Summary and Schedule of Benefits

• Summary of Benefits and Coverage (SBCs)
• Schedule of Benefits (SOBs)

Transition and Continuity of Care

• Continuity of Care/Transition of Care Request Form, English l Spanish
• Understanding Transition of Care
• Understanding Continuity of Care

Medical Drug Authorizations

• Commercial Medical Drug Step Therapy (09/01/2026)
• Medical Drug Coverage Policy – General Policy (09/01/2026)
• Medical Drug Coverage Policy – Specific Policies (09/01/2026)
• Preferred Diabetic Testing Supplies (01/01/2025)
• Medical Drug Prior Authorization List (09/01/2026)
• Prior Drug Authorization Criteria
• Pharmacy Prior Authorization Form

Medical Prior Authorizations

• Medical Prior Authorization List (11/01/2026)
• Medical Prior Authorization List Changes (11/01/2026)
• Medical Prior Authorization Form

• Online directory
• Printable directory (including Pharmacy), English | Spanish (coming soon)
• 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

Download or print the directory to find in-network doctors and specialists. Directory information is current as of the date on the cover. For the latest information, use the online directory.

• Online directory
• Printable directory (including Pharmacy), English | Spanish
• 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

• Continuous Glucose Monitoring (CGM) (MP 0101)
• MOHS Micrographic Surgery (MP 0111)
• Erectile Dysfunction (ED) Treatment (MP 0112)
• Orthognathic (Jaw) Surgery (MP 0135)
• Home Births (MP 0171)
• Breast Surgery (MP 0173)
• Bone Growth Stimulation (Osteogenic) (MP 0181)
• Bronchial Thermoplasty (MP 0187)
• Autologous Condrocyte Implants (MP 0189)
• LINX™Reflux Management System (MP 0191)
• Drug Testing in Pain Management and Substance Abuse Treatment (MP 0192)
• Gender Affirmation Surgery (MP 0193)
• Bioengineered Skin and Soft Tissue Substitute (MP 0196)
• Wearable Cardioverter Defibrillator (MP 0209)
• Surgical Treatment of Gastroesophageal Reflux Disease (GERD) (MP 0211)
• Vulvectomy (MP 0215)
• DaT Scan (MP 0222)
• Genetic Testing for Screening Diagnosis, Treatment, & Monitoring of Cancer (MP 0223)
• Pharmacogenetic Testing Policy (MP 0226)
• Genetic Testing for Hereditary (MP 0227)
• Prophylactic Surgery (MP 0228)
• MP 0229 Thermal Destruction of the Intraosseous Basivertebral Nerve (Intracept® Procedure) (MP 0229)
• Hypoglossal Nerve Stimulation Implant (Inspire TM ) (MP 0230)
• Chimeric Antigen Receptor (CAR) T-cell therapy (MP 0231)
• Optimizer (Individual and Family Plans) (MP 0232)
• Baroflex Activation Therapy (BAT) Barostim® (MP 0233)
• Routine Costs Associated with Clinical Trials (MP 0236)
• Vivostim (MP 0238)
• 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)
• Solid Organ Transplant - Lung Transplantation (MP 0243)
• Spinal Fusion Surgery (MP 0244)
• Appropriate Professionals Procedure
• Appropriate Professionals Policy
• Clinical Criteria for Utilization Management (UM)  Decision Making Procedure
• Clinical Criteria for Utilization Management (UM) Decision Making Policy

• Click here for a list of tips on staying healthy and managing health conditions. 

• Check the guidelines here.

• Check the guidelines here.