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Member Materials

Forms, notices, member handbooks and more for your reference

NOTE: You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here. 

IEHP DualChoice

Learn about any changes to your IEHP DualChoice plan for the current year.

2024 IEHP DualChoice Annual Notice of Changes
2025 IEHP DualChoice Annual Notice of Changes

 

 

Appoint a trusted person to act as your representative for IEHP DualChoice services.

IEHP DualChoice Appointment of Representative Form (PDF), Updated 9/24/23

 

Find everything you need to know about your IEHP DualChoice plan.

2024 IEHP DualChoice Member Handbook (PDF), Updated 10/13/23
2025 IEHP DualChoice Member Handbook (PDF), Updated 10/15/24

 

Learn about all your IEHP DualChoice benefits.

2024 IEHP DualChoice Summary of Benefits (PDF), Updated 10/13/23
2025 IEHP DualChoice Summary of Benefits (PDF), Updated 10/15/24

 

IEHP DualChoice Provider Directory
Choose the right providers for you who accept IEHP DualChoice.

 

IEHP DualChoice Formularies
Find info about which prescription drugs IEHP DualChoice covers:

 

More Information
Here’s everything else you may need as an IEHP DualChoice member.

    Medi-Cal

    Learn everything you need to know about your Medi-Cal plan.

    Medi-Cal Member Handbook and Evidence of Coverage

     

    Medi-Cal Provider Directory


    Choose the right providers for you who accept Medi-Cal.

     

    Find out how you can file an appeal.

    Medi-Cal Member Appeals Resolution Process

     

    Here’s everything else you may need as a Medi-Cal member.

    More Information

      IEHP Covered California

      Choose the right providers for you who accept IEHP Covered.

      IEHP Covered Provider Directory

       

      Find everything you need to know about your IEHP Covered plan, including benefits and your out-of-pocket costs.

      Evidence of Coverage

       

      Find info about which prescription drugs IEHP Covered covers.

      IEHP Covered California Formulary

       

      Here’s everything else you may need as an IEHP Covered member.

      Other Benefit Information

        IEHP Forms

        Appoint a trusted person to act as your representative for selected IEHP services.

        Appointment of Representative Form

         

        Update your contact info for receiving communications about your medical information.

        IEHP Confidential Communication Request (CCR)

         

        Request protected health information records.

        IEHP Authorization for Use and Disclosure of Protected Health Information

         

        File a grievance.

        Grievance Form

         

        File a grievance through the mail.

        IEHP Covered Grievance Form Print Out

          IEHP DualChoice (HMP D-SNP) is an HMO Plan with a Medicare contract. Enrollment in IEHP DualChoice (HMO D-SNP) depends on contract renewal.

           

          Information on this page is current as of October 15, 2024.
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