Forms

Forms

Plan
PHCS Network Plans (51+) For Plans that access the PHCS Network   Download
Cigna Plans (51+) For Plans that access the Cigna PPO Network   Download
MEC Plan (51+)   Download
MEC Advanced Plan (51+)   Download
Dental
Self-Funded ASO Dental   Download
Overview
Self-Funded Plan Details 2018   Download
Find A Provider (PCHS - Multiplan)   Download
Find a Provider (For Plans that access Cigna PPO Networks)   Download
Member Web Portal Form (HMA)   Download
Member Web Portal Form (For Plans that access Cigna PPO Networks)   Download
Other
Cigna PBM Pharmacy Claim Form
Enrollment Packet (Medi-CAL) 2015   Download
HMA
HMA & US Health Center Overview   Download
HMA Medical Claim Form   Download
HMA Transition of Care Form   Download
SS
S & S Overview   Download
S & S Medical Claim Form   Download
S & S Transition of Care Form   Download
WellDyne
WellDyne RX Claim Form   Download
WellDyne Mail Order Form (English & Spanish)   Download
WellDyne PBM Overview   Download

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