PHC California

Rachel Sakai
AHF Provider

Publications and Forms

These publications and forms are for plan members.  If you need a publication or form that isn’t here, contact Member Services.  If you want a printed copy of any of the items here, contact Member Services.

• Membership Guide (Combined Evidence of Coverage and Disclosure Form) (revised July 2018)
• Comprehensive Formulary (effective March 2018)
• Provider and Pharmacy Directory (effective December 1, 2018)
  You can search for providers, facilities and pharmacies online.  Go to the Network Provider, Facility and Pharmacy Search page.
• Health and Wellness Benefit Election Form
• Authorization for Use or Disclosure of Health Information
• Complaint and Grievance Form
• Notice of Privacy Practices

You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.