Forms and Documents

These forms and documents are available as PDF files. Just click on a form or document to download it. You will need Adobe Reader to view these files; this can be downloaded free of charge at Adobe's site.

If you have medical coverage, the following forms and documents are for you:

Preferred Drug List (PDL)

Mail Service Registration and Prescription Order Form

Member Handbook (includes document of coverage information)

Over-the-Counter Benefits Catalog

Provider Directory

Pharmacy Directory

DCFS Youth In Care Program

If you have MLTSS coverage, the following forms and documents are for you:

Member Handbook (includes document of coverage information)

MLTSS Over-the-Counter Benefits Catalog 

Provider Directory

Waiver Handbooks

Long-Term Supports and Services (LTSS) Waiver Handbook

Brain Injury Waiver Handbook

Disabilities Waiver Handbook

Elderly Waiver Handbook

HIV/AIDS Waiver Handbook

Supportive Living Waiver Handbook

Additional Documents

Critical Incident Form for Members

Frequently Asked Questions

Multi-language Insert

HIPAA Notice of Privacy Practices

Authorized Representative Designation Form

Transportation Mileage Reimbursement Trip Log

Member Rights and Responsibilities
 

Find a Doctor or Hospital

Use our Provider Finder® to search for doctors and other health care providers near you.

Need Help?

1-877-860-2837 (TTY/TDD 711)

We are available 24 hours a day, seven (7) days a week. The call is free.