Publications and Forms

The following publications and forms are for plan members. All publications below are applicable to the plan year indicated. If you need a publication or form that is not listed below, please contact Member Services. If you would like a printed copy of any of the documents below, please contact Member Services.

2020 Plan Publications

2020 Summary of Benefits
2020 Quality and Performance Ratings (Every year, Medicare evaluates plans based on a 5-star rating system.)
2020 Annual Notice of Changes (ANOC)
2020 Evidence of Coverage
2020 Comprehensive Formulary (effective March 1, 2020; last updated February 25, 2020)
2020 Prescription Drug Prior Authorization Criteria (effective March 1, 2020)
2020 Prescription Drug Step Therapy Criteria (effective March 1, 2020)

Provider and Pharmacy Directories

Search online using our Network Provider/Facility/Pharmacy Search application
Provider and Part B Pharmacy Directory (last updated November 1, 2019)
Part D Pharmacy Directory (last updated November 1, 2019)

To report any errors in the PHP provider or pharmacy, please send an email to [email protected], or send a message using our web form. You may also report directory errors by calling Member Services at (800) 263-0067, Option 2 (TTY 711). Agents are available 8:00 am to 8:00 pm, seven days a week.

Other Publications and Forms

Appointment of a Representative Form and Information
Notice of Privacy Practices
Health and Wellness Benefit Option Election
Over-the-Counter Pharmacy Order Form (effective April 13, 2020)
Enrollee Demographics Questionnaire

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.

H5852_4006 101519_2020

PHP, California