Forms and Resources

The following listings are forms and resources you may need as a member of the Alliance. If you need help, call the Alliance Member Services Department at (800) 700-3874.

Notice of Privacy Forms

Personal Representative Request

Authorization to Use or Disclose Protected Health Information

Member Reimbursement Claim Form

Other Health Coverage (OHC)

If you have Medi-Cal and other health insurance, you will need to update your information with your local county either by phone or online.

To update by phone:

Merced County
Monterey County
Santa Cruz County

To update on the California Department of Health Care Services (DHCS) website:

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