Your Member Handbook is an important legal document that gives you details about how to get the health care you need as a member of the PacificSource Community Solutions Coordinated Care Organization (CCO).
To view your Member Handbook, choose an option below based on where you live:
Text4Baby
Text BABY to 511411 to get free tips to help you with your pregnancy and your baby’s first year.
Living Well with Chronic Conditions
Living Well with Chronic Conditions (the Chronic Disease Self-Management Program, or CDSMP) is a six-week workshop that provides tools for living a healthy life with chronic health conditions, including diabetes, arthritis, asthma and heart disease. Through weekly sessions, the workshop provides support for continuing normal daily activities and dealing with the emotions that chronic conditions may bring about.
Childhood Immunization Schedule
The Schedules list the age or age range when each vaccine or series of shots is recommended. If your child (birth through 6 years old) or adolescent (age 7 through 18 years old) has missed any shots, consult the catch-up schedule AND check with the doctor about getting back on track.
Quit For Life® Program
The Quit For Life® Program is the nation’s top stop smoking program. It can help you beat your need for tobacco for good. The program uses a mix of tools including telephone and website coaching and a quit tobacco plan built for you.
Expert coaches help you learn skills and give you tools to quit tobacco for life. The program uses a four-step plan. When you get good at the four steps, your chance of quitting is eight times more than if you try to quit cold turkey. The program is free, confidential, and it works.
Call 1-866-QUIT-4-LIFE, (866) 784-8454 toll-free, or log on to www.QuitNow.net for details or to enroll. TTY users should call (877) 777-6534.
24-Hour NurseLine
As a member of our plan, you have access to a free 24-Hour NurseLine. The NurseLine is available 24-hours, 7 days a week.
You can call our free 24-Hour NurseLine any time of the night or day to receive trusted health information and advice from
the comfort of your home. A nurse will call you back with additional advice and information based on your health questions and needs.
When should you call the 24-Hour NurseLine?
Appointment of Representative Form
Use this form if you want someone else to file a complaint or appeal on your behalf. Both you and your representative must sign and date this form. Send it together with your complaint or appeal form.
Authorization to Release Healthcare Information
Use this form to name a person(s) to whom the Plan will be able to release your healthcare information (for example, if they call Customer Service for claims or pre-authorization information). This does not allow the designated person(s) to make healthcare decisions on your behalf.
Member Appeal Form
Use this form if you want to appeal a decision by the Plan to deny coverage of a service.
Member Complaint Form
Use this form for complaints about issues that do not involve a denial of coverage of services; for example, complaints about scheduling problems, customer service issues, quality of care, etc. You can also use this form if you feel you have experienced discrimination when accessing health services or interacting with our plan.
Prescription Drug Refund Form
Use this form to ask for a refund of any prescription drugs you had to pay for out of pocket.
Wellpartner Pharmacy Order Form
Use this form for mail order requests from Wellpartner. Simply print the form then follow the directions to mail or fax it to Wellpartner directly.
CVS Pharmacy Order Form
Use this form for mail order requests from CVS.
Primary Care Provider Change Form
Fill out this form and return it to us by fax, mail or email to make the change.