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2019 Forms and Brochures
Enrollment applications
HMO
HSP
EPO
PPO
EnhancedCare PPO
Other Enrollment Forms
- Understanding Health Care Coverage - English (PDF)
- Understanding Health Care Coverage - Spanish (PDF)
- Continuity of Care Assistance Request Form - English (PDF)
- Continuity of Care Assistance Request Form - Spanish (PDF)
Travel Guides
Department of Managed Health Care (DMHC)
Compliance Forms
- Authorization for Disclosure of Protected Health Information - English (PDF)
- Authorization for Disclosure of Protected Health Information - Spanish (PDF)
- Authorization for Disclosure of Protected Health Information - Chinese (PDF)
- Authorization for Disclosure of Protected Health Information - Korean (PDF)
- Glossary of Health Coverage and Medical Terms - English (PDF)
- Glossary of Health Coverage and Medical Terms - Spanish (PDF)
- Glossary of Health Coverage and Medical Terms - Chinese (PDF)
- Glossary of Health Coverage and Medical Terms - Korean (PDF)
- Glossary of Health Coverage and Medical Terms - Navajo (PDF)
Health insurance companies and group health plans are required to make available a uniform glossary of health coverage and medical terms commonly used in plan documents. The Uniform Glossary is meant to help the consumer understand some of the most common language used in health insurance documents. Please log in to request a hardcopy of the document by mail.
2018 Forms and Brochures
Enrollment applications
HMO
- IFP CommunityCare HMO Enrollment Application - English (PDF)
- IFP CommunityCare HMO Enrollment Application - Spanish (PDF)
- IFP CommunityCare HMO Enrollment Application - Chinese (PDF)
- IFP CommunityCare HMO Enrollment Application - Korean (PDF)
HSP
- IFP PureCare HSP Enrollment Application - English (PDF)
- IFP PureCare HSP Enrollment Application - Spanish (PDF)
- IFP PureCare HSP Enrollment Application - Chinese (PDF)
- IFP PureCare HSP Enrollment Application - Korean (PDF)
EPO
- IFP PureCare One EPO Enrollment Application - English (PDF)
- IFP PureCare One EPO Enrollment Application - Spanish (PDF)
- IFP PureCare One EPO Enrollment Application - Chinese (PDF)
- IFP PureCare One EPO Enrollment Application - Korean (PDF)
PPO
- IFP PPO Enrollment Application - English (PDF)
- IFP PPO Enrollment Application - Spanish (PDF)
- IFP PPO Enrollment Application - Chinese (PDF)
- IFP PPO Enrollment Application - Korean (PDF)
EnhancedCare PPO
- IFP EnhancedCare PPO Enrollment Application - English (PDF)
- IFP EnhancedCare PPO Enrollment Application - Spanish (PDF)
- IFP EnhancedCare PPO Enrollment Application - Chinese (PDF)
- IFP EnhancedCare PPO Enrollment Application - Korean (PDF)
Other Enrollment Forms
- Understanding Health Care Coverage - English (PDF)
- Understanding Health Care Coverage - Spanish (PDF)
- Continuity of Care Assistance Request Form - English (PDF)
- Continuity of Care Assistance Request Form - Spanish (PDF)
Travel Guides
Department of Managed Health Care (DMHC)
Compliance Forms
- Authorization for Disclosure of Protected Health Information - English (PDF)
- Authorization for Disclosure of Protected Health Information - Spanish (PDF)
- Authorization for Disclosure of Protected Health Information - Chinese (PDF)
- Authorization for Disclosure of Protected Health Information - Korean (PDF)
- Glossary of Health Coverage and Medical Terms - English (PDF)
- Glossary of Health Coverage and Medical Terms - Spanish (PDF)
- Glossary of Health Coverage and Medical Terms - Chinese (PDF)
- Glossary of Health Coverage and Medical Terms - Korean (PDF)
- Glossary of Health Coverage and Medical Terms - Navajo (PDF)
Health insurance companies and group health plans are required to make available a uniform glossary of health coverage and medical terms commonly used in plan documents. The Uniform Glossary is meant to help the consumer understand some of the most common language used in health insurance documents. Please log in to request a hardcopy of the document by mail.