You can get the information and care that you need quickly with these commonly-requested forms.
At some point during your care, you may want us to disclose your protected health information to someone else, like a partner or child. Here you’ll find the form you’ll need to authorize the release of that information.
If you’ve recently changed health insurance providers, you may be eligible to receive a credit for money applied toward your deductible with your previous health plan. Find out if you qualify and learn how to request a deductible credit.
You can use this form to select or change your Primary Care Physician.
If you're looking to be reimbursed for eligible out-of-pocket medical expenses, be sure to submit this reimbursement request form within 180 days of the date of service.
If your doctor has prescribed a medication you’ve purchased from a pharmacy within the last 180 days, then you might be eligible for a reimbursement. Find out if you qualify and learn how to submit a request.
To help your healthcare providers coordinate the best possible care for you, you can authorize your medical information and history to be integrated into one place that your providers can easily access. See how continuity of care benefits can improve your overall health care experience.
Regulations may require pharmacies to get prior authorization before dispensing certain medications. Here's the form your prescriber will need to complete these requests, including those for step therapy. Please fax the following completed form to 1.858.357.2534.
Fill out this form if you would like to make changes to, or update the personal information associated with, your individual and family plan.
Covered CA members please contact Covered CA at 1.800.300.1506 or update your account online at coveredca.com.
Please complete this form if you would like to cancel your individual and family plan. Then submit the form by mail, in person, or by fax.
Let’s talk. Call us at 1.800.359.2002 or send us a message
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