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Member Documents

Important documents for AlohaCare QUEST Integration members.

 
 QUEST Integration

Click here to request hard copies of any of these materials. Hard copies are free upon request and will be provided within five business days.

Member Handbook

 The Member Handbook tells you about your benefits and the programs that are available to you as an AlohaCare member.

Provider Directory

 This directory is a list of network providers.

PCP Change form

 This form lets you change your Primary Care Provider (PCP)

Pharmacy Lock-In & Designated Prescriber Change Form

 If you are enrolled in the Pharmacy Home Program, this form lets you change your Pharmacy Home or Designated Prescriber.

CarelonRx Home Delivery Mail Service Order Form

 Complete and mail in this form to sign up to have medicine you take on a regular basis to be delivered to your home.

Appointment of Representative Form

 This form gives permission for a person to act on your behalf to file a grievance, appeal or coverage determination for you.

Privacy Notice

 This notice describes how medical information about you may be used and shared and obtained.

Protected Health Information Form

 This form lets you choose who to share information with and what information to share.

Member Newsletter

 Our member newsletter offers members general health advice and information about our services.

Prescription Reimbursement Claim Form

 This form allows you to file a claim if you paid out of pocket for a prescription. All claims are subject to review and approval. Please remember to always show your member ID card before picking up a prescription.

Injury/Illness Form

 Please complete this form if your injury or illness happened at work or as a result of an automobile accident.
Non-Emergent Medical Transportation: IntelliRide Starting March 1, 2021, IntelliRide will make your travel arrangements.

Health Risk Assessment