Resources / Materials
Los Angeles
- Los Angeles ANOC - English (PDF) - coming soon
- Los Angeles ANOC - Español (PDF) - coming soon
- Los Angeles ANOC - Arabic العربية (PDF) - coming soon
- Los Angeles ANOC - Armenian Հայերեն (PDF) - coming soon
- Los Angeles ANOC - Cambodian ខ្មែរ (PDF) - coming soon
- Los Angeles ANOC - Chinese 中文 (PDF) - coming soon
- Los Angeles ANOC - Farsi/Persian فارسی (PDF) - coming soon
- Los Angeles ANOC – Korean 한국어 (PDF) - coming soon
- Los Angeles ANOC - Russian Русский язык (PDF) - coming soon
- Los Angeles ANOC - Tagalog (PDF) - coming soon
- Los Angeles ANOC - Vietnamese Tiếng Việt (PDF) - coming soon
San Diego
- San Diego ANOC - English (PDF) - coming soon
- San Diego ANOC - Español (PDF) - coming soon
- San Diego ANOC - Arabic العربية (PDF) - coming soon
- San Diego ANOC - Tagalog (PDF) - coming soon
- San Diego ANOC - Vietnamese Tiếng Việt (PDF) - coming soon
Los Angeles
- Los Angeles Member Handbook - English (PDF) - coming soon
- Los Angeles Member Handbook - Español (PDF) - coming soon
- Los Angeles Member Handbook - Arabic العربية (PDF) - coming soon
- Los Angeles Member Handbook - Armenian Հայերեն (PDF) - coming soon
- Los Angeles Member Handbook - Cambodian ខ្មែរ (PDF) - coming soon
- Los Angeles Member Handbook - Chinese 中文 (PDF) - coming soon
- Los Angeles Member Handbook - Farsi/Persian فارسی (PDF) - coming soon
- Los Angeles Member Handbook - Korean 한국어 (PDF) - coming soon
- Los Angeles Member Handbook - Russian Русский язык (PDF) - coming soon
- Los Angeles Member Handbook - Tagalog (PDF) - coming soon
- Los Angeles Member Handbook - Vietnamese Tiếng Việt (PDF) - coming soon;
San Diego
- San Diego Member Handbook - English (PDF) - coming soon
- San Diego Member Handbook - Español (PDF) - coming soon
- San Diego Member Handbook - Arabic العربية (PDF) - coming soon
- San Diego Member Handbook - Tagalog (PDF) - coming soon
- San Diego Member Handbook - Vietnamese Tiếng Việt (PDF) - coming soon
Los Angeles
- Los Angeles Summary of Benefits - English (PDF) - coming soon
- Los Angeles Summary of Benefits - Español (PDF) - coming soon
- Los Angeles Summary of Benefits - Arabic - العربية (PDF) - coming soon
- Los Angeles Summary of Benefits - Armenian - Հայերեն (PDF) - coming soon
- Los Angeles Summary of Benefits - Cambodian - ខ្មែរ (PDF) - coming soon
- Los Angeles Summary of Benefits - Chinese - 中文 (PDF) - coming soon
- Los Angeles Summary of Benefits - Farsi/Persian - فارسی (PDF) - coming soon
- Los Angeles Summary of Benefits - Korean - 한국어 (PDF) - coming soon
- Los Angeles Summary of Benefits - Russian - Русский (PDF) - coming soon
- Los Angeles Summary of Benefits - Tagalog (PDF) - coming soon
- Los Angeles Summary of Benefits - Vietnamese - Tiếng Việt (PDF) - coming soon
San Diego
- San Diego Summary of Benefits - English (PDF) - coming soon
- San Diego Summary of Benefits - Español (PDF) - coming soon
- San Diego Summary of Benefits - Arabic - العربية (PDF) - coming soon
- San Diego Summary of Benefits - Tagalog (PDF) - coming soon
- San Diego Summary of Benefits - Vietnamese - Tiếng Việt (PDF) - coming soon
Quiz
Los Angeles
- Quiz - English (PDF)
- Quiz - Español (PDF)
- Quiz - Armenian - Հայերեն (PDF)
- Quiz - Cambodian - ខ្មែរ (PDF)
- Quiz - Chinese - 中文 (PDF)
- Quiz - Hmong - Hmoob (PDF)
- Quiz - Korean - 한국어 (PDF)
- Quiz - Russian - Русский (PDF)
- Quiz - Vietnamese - Tiếng Việt (PDF)
Fact Sheet
Los Angeles
- Fact Sheet - English (PDF)
- Fact Sheet - Español (PDF)
- Fact Sheet - Armenian - Հայերեն (PDF)
- Fact Sheet - Cambodian - ខ្មែរ (PDF)
- Fact Sheet - Chinese - 中文 (PDF)
- Fact Sheet - Hmong - Hmoob (PDF)
- Fact Sheet - Korean - 한국어 (PDF)
- Fact Sheet - Russian - Русский (PDF)
- Fact Sheet - Vietnamese - Tiếng Việt (PDF)
Checklist
Los Angeles
- Checklist - English (PDF)
- Checklist - Español (PDF)
- Checklist - Armenian - Հայերեն (PDF)
- Checklist - Cambodian - ខ្មែរ (PDF)
- Checklist - Chinese - 中文 (PDF)
- Checklist - Hmong - Hmoob (PDF)
- Checklist - Korean - 한국어 (PDF)
- Checklist - Russian - Русский (PDF)
- Checklist - Vietnamese - Tiếng Việt (PDF)
Benefit Highlights
Los Angeles
- Benefit Highlights - English (PDF)
- Benefit Highlights - Español (PDF)
- Benefit Highlights - Armenian - Հայերեն (PDF)
- Benefit Highlights - Cambodian - ខ្មែរ (PDF)
- Benefit Highlights - Chinese - 中文 (PDF)
- Benefit Highlights - Hmong - Hmoob (PDF)
- Benefit Highlights - Korean - 한국어 (PDF)
- Benefit Highlights - Russian - Русский (PDF)
- Benefit Highlights - Vietnamese - Tiếng Việt (PDF)
Care Coordination
Los Angeles
- Care Coordination - English (PDF)
- Care Coordination - Español (PDF)
- Care Coordination - Armenian - Հայերեն (PDF)
- Care Coordination - Cambodian - ខ្មែរ (PDF)
- Care Coordination - Chinese - 中文 (PDF)
- Care Coordination - Hmong - Hmoob (PDF)
- Care Coordination - Korean - 한국어 (PDF)
- Care Coordination - Russian - Русский (PDF)
- Care Coordination - Vietnamese - Tiếng Việt (PDF)
Los Angeles Directories
- Provider & Pharmacy Directory Vol. 1 - Los Angeles County, CA Region: Antelope Valley; San Fernando Valley (less Burbank and Glendale) - English (PDF)
- Provider & Pharmacy Directory Vol. 2 - Los Angeles County, CA Region: Burbank, Glendale - English (PDF)
- Provider & Pharmacy Directory Vol. 3 - Los Angeles County, CA Region: San Gabriel Valley (South / West) - English (PDF)
- Provider & Pharmacy Directory Vol. 4 - Los Angeles County, CA Region: San Gabriel Valley (North / East) - English (PDF)
- Provider & Pharmacy Directory Vol. 5 - Los Angeles County, CA Region: Metro (North / East) - English (PDF)
- Provider & Pharmacy Directory Vol. 6 - Los Angeles County, CA Region: Metro (South / West) - English (PDF)
- Provider & Pharmacy Directory Vol. 7 - Los Angeles County, CA Region: West and South LA - English (PDF)
- Provider & Pharmacy Directory Vol. 8 - Los Angeles County, CA Region: East LA (West) - English (PDF)
- Provider & Pharmacy Directory Vol. 9 - Los Angeles County, CA Region: East LA (East) - English (PDF)
- Provider & Pharmacy Directory Vol. 10 - Los Angeles County, CA Region: South Bay - English (PDF)
San Diego Directories
- Provider & Pharmacy Directory - San Diego County, CA - English (PDF)
National Coverage Determination Notice
- National Coverage Determination Notice - English (PDF)
- National Coverage Determination Notice - Español (PDF)
- National Coverage Determination Notice - Arabic - العربية (PDF)
- National Coverage Determination Notice - Armenian - Հայերեն (PDF)
- National Coverage Determination Notice - Chinese - 中文 (PDF)
- National Coverage Determination Notice - Cambodian - ខ្មែរ (PDF)
- National Coverage Determination Notice - Farsi/Persian - فارسی (PDF)
- National Coverage Determination Notice - Korean - 한국어 (PDF)
- National Coverage Determination Notice - Russian - Русский (PDF)
- National Coverage Determination Notice - Tagalog (PDF)
- National Coverage Determination Notice - Vietnamese - Tiếng Việt (PDF)
Los Angeles and San Diego
- List of Drugs - English (PDF) - coming soon
- List of Drugs - Spanish (PDF) - coming soon
- List of Drugs - Arabic العربية (PDF) - coming soon
- List of Drugs - Armenian Հայերեն (PDF) - coming soon
- List of Drugs - Chinese 中文 (PDF) - coming soon
- List of Drugs - Cambodian ខ្មែរ (PDF) - coming soon
- List of Drugs - Farsi/Persian فارسی (PDF) - coming soon
- List of Drugs - Korean 한국어 (PDF) - coming soon
- List of Drugs - Russian Русский язык (PDF) - coming soon
- List of Drugs - Tagalog (PDF) - coming soon
- List of Drugs - Vietnamese Tiếng Việt (PDF) - coming soon
Transition of Care Form
Scope of Appointment
Notice of Privacy Practices
- Notice of Privacy Practices - English (PDF)
- Notice of Privacy Practices - Español (PDF)
- Notice of Privacy Practices - Arabic - العربية (PDF)
- Notice of Privacy Practices - Armenian - Հայերեն (PDF)
- Notice of Privacy Practices - Cambodian - ខ្មែរ (PDF)
- Notice of Privacy Practices - Chinese - 中文 (PDF)
- Notice of Privacy Practices - Farsi/Persian - فارسی (PDF)
- Notice of Privacy Practices - Korean - 한국어 (PDF)
- Notice of Privacy Practices - Russian - Русский (PDF)
- Notice of Privacy Practices - Tagalog (PDF)
- Notice of Privacy Practices - Vietnamese - Tiếng Việt (PDF)
Authorization to Disclose Protected Health Information
- Authorization to Disclose Protected Health Information - English (PDF)
- Authorization to Disclose Protected Health Information - Español (PDF)
- Authorization to Disclose Protected Health Information - Arabic - العربية (PDF)
- Authorization to Disclose Protected Health Information - Armenian - Հայերեն (PDF)
- Authorization to Disclose Protected Health Information - Cambodian - ខ្មែរ (PDF)
- Authorization to Disclose Protected Health Information - Chinese - 中文 (PDF)
- Authorization to Disclose Protected Health Information - Farsi/Persian - فارسی (PDF)
- Authorization to Disclose Protected Health Information - Korean - 한국어 (PDF)
- Authorization to Disclose Protected Health Information - Russian - Русский (PDF)
- Authorization to Disclose Protected Health Information - Tagalog (PDF)
- Authorization to Disclose Protected Health Information - Vietnamese - Tiếng Việt (PDF)
Confidential Communication Request
- Confidential Communication Request - Español (PDF)
- Confidential Communication Request - Arabic - العربية (PDF)
- Confidential Communication Request - Armenian - Հայերեն (PDF)
- Confidential Communication Request - Cambodian - ខ្មែរ (PDF)
- Confidential Communication Request - Chinese - 中文 (PDF)
- Confidential Communication Request - Farsi/Persian - فارسی (PDF)
- Confidential Communication Request - Korean - 한국어 (PDF)
- Confidential Communication Request - Russian - Русский (PDF)
- Confidential Communication Request - Tagalog (PDF)
- Confidential Communication Request - Vietnamese - Tiếng Việt (PDF)
Mail Order Pharmacy
- CVS Caremark Mail Order Form - English (PDF)
- CVS Caremark Mail Order Form - Spanish (PDF)
- Homescripts Mail Order Form - English (PDF)
- Homescripts Mail Order Form - Spanish (PDF)
Medication Therapy Management
Prescription Claims
Your current plan may have an over-the-counter (OTC) benefit that lets you buy OTC health and wellness products. This catalog includes a list of OTC items that you can order to be mailed your home. Check the catalog for item limits.
Ordering is easy. Just follow the steps in your plan's catalog.
- Over-the-Counter Catalog - English / Spanish (PDF) - coming soon