Member Handbook, Provider Directory, Preferred Drug List, Forms, and Policies
Here are links to the manuals, forms, and policies available to you.
- Designation of Authorized Representative Form (PDF)
- Authorization to Use and Disclose Health Information (PDF)
- Revocation of Authorization to Use and/or Disclose Health Information (PDF)
- Request for Amendment of Health Information (PDF)
- Request for Accounting of Disclosures of Health Information (PDF)
- Request for Restrictions on Use and Disclosure of Health Information (PDF)
- Request for Accessing/Inspecting/Copying Health Information (PDF)
Value-Added Services Forms
- Over-the-Counter Health and Wellness Catalog (PDF)
- WW Program Physician Referral Form (PDF)
- YMCA Diabetes Prevention Program and Blood Pressure Self-Monitoring Program (BPSM) Physician Referral Form (PDF)
- New Mother's Package Online Web Form
- After School/Youth Organization Online Web Form
- Educational Support Online Web Form
Any documents and items offered in electronic format can be requested in paper format. To request a document in paper format, please contact Member Services at 1-833-552-3876 (TTY: 711).
Once you have completed your request, the paper format item(s) will be mailed within 7 business days from the date of the request.