Member Materials

Member Handbook

Your Member Handbook is your go-to guide to Healthy Blue benefits. Read it to find out about: 

  • Your benefits and how to use them. 
  • How to choose a primary care provider (PCP). 
  • Where to go to for help after hours. 
  • Who to call when you have questions. 
  • Your rights and responsibilities as a Healthy Blue member. 

 

Member Handbook — English 

Member Handbook — Spanish 

Member Handbook Change Control Log — English 

Member Handbook Change Control Log — Spanish 

Need a Printed Member Handbook? 

Call us at 866-781-5094 (TTY: 866-773-9634) to get a printed member handbook mailed to you at no cost. 

 

Other Important Documents

Pharmacy

Zero Dollar Copay List — English 

Zero Dollar Copay List — Spanish 

Preferred Drug List — English 

Preferred Drug List — Spanish 

Common Over-the-Counter Medicines — English 

Common Over-the-Counter Medicines — Spanish 

CarelonRx Reimbursement Form — English 

CarelonRx Reimbursement Form — Spanish

Medical Appeals 

Appeal Request Form — English 

Appeal Request Form — Spanish 

Appeal Representative Form — English 

Appeal Representative Form — Spanish

Pharmacy Appeals

Appeal Request Form — English 

Appeal Request Form — Spanish 

Appeal Representative Form — English 

Appeal Representative Form — Spanish

Medical Grievances

Grievance Request Form — English 

Grievance Request Form — Spanish

Grievance Representative Form — English 

Grievance Representative Form — Spanish 

Pharmacy Grievances

Grievance Request Form — English 

Grievance Request Form — Spanish

Grievance Representative Form — English 

Grievance Representative Form — Spanish 

Quality Improvement Program 

Quality Improvement Program — English 

Quality Improvement Program — Spanish 

Personal Health Assessments (PHA)

Personal Health Assessment for Adults — English

Personal Health Assessment for Children — English 

Personal Health Assessment for Adults — Spanish 

Personal Health Assessment for Children — Spanish 

Preventive Health Guidelines

Preventative Health Guidelines — English  

2023 Documents 

2023 Evidence of Coverage (EOC) - English 

2023 Evidence of Coverage (EOC) - Spanish

2023 Member Appeals Request Form 

2023 Member Appeals Representative Form - English 

2023 Member Appeals Representative Form - Spanish 

2023 Member Grievance Form 

2023 Fraud Referral Form