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Documents and Resources

Forms and Policies

Accessing Care During a Disaster

Appointment of Representative (AOR) Form

Diabetes Prevention Program (MDPP)

Flex Card Refund Form

Fraud, Waste and Abuse Reporting

HIPAA Release Form

LIS Premium Summary Chart

Medical Management Policies & Transparency Tool

Medicare Coverage Requests, Appeals, and Grievances

Member Complaint and Appeal Form

Non-Discrimination Policy

Notice of Privacy Practices

Transition of Care Form (New Members)

Report a Compliance Concern

Terms and Conditions

Prescription Drug and Pharmacy Information

More Great Benefits

Thank you for choosing Peak! Please see the contact information below for the exciting supplemental benefits you now have access to as a Peak member.  Please reference your benefit summary for details regarding these benefits.

Benefit

Member Service Phone Number

Web Address

Flexible Spending Card

Over-the-Counter (OTC)

Transportation – Modivcare

Fitness Membership – One Pass

Post Discharge Meals – GA Foods