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Forms & Resources

Resources for PEEHIP Members (non-smokers)

Legal Documents
  • Privacy Notice
    Amended 1/1/2023 →
  • Certificate of Coverage
    2022-2023 →
  • Cost Calculator Notices and Disclaimers
    2023 →
  • Wellness Benefits for Wellness Plans
    Effective 1/1/2023 →
  • Summary of Benefits and Coverage
    2022-2023 →
  • Summary of Benefits
    2022-2023 →
  • Summary of Benefits and Coverage
    2021-2022 →
  • Certificate of Coverage
    2021-2022 →
  • Summary of Benefits
    2021-2022 →
  • Non-Discrimination and Language Accessibility Notice
    Effective Oct. 2016 →
    • Additional Program Benefits
  • Recommended Immunizations for Children from 7 to 18 Years Old
    2023 →
  • Recommended Immunizations for Adults 19+
    2023 →
  • Recommended Immunizations for Children from Birth to 6 Years Old
    2023 →
  • FAQs Related to Coverage of At-Home COVID-19 Tests
    2/7/2022 →
  • Bright Futures Preventive Pediatric Health Care Recommendations
    Effective January 2022 →
  • Teladoc Telehealth Services
    →
  • Teladoc Telehealth Mental Health Services
    Effective January 2021 →
  • Health Benefits FAQ
    effective 1/1/2021 →
    • Pharmacy Policies - General
  • Plan Formulary
    Effective 1/1/2023 →
    • Welcome to Viva
  • Appointment of Representative
    Complaints Process →
  • Personal Representative Appointment Form
    →

    • Resources for PEEHIP Members (smokers)

    Legal Documents
  • Privacy Notice
    Amended 1/1/2023 →
  • Certificate of Coverage
    2022-2023 →
  • Cost Calculator Notices and Disclaimers
    2023 →
  • Wellness Benefits for Wellness Plans
    Effective 1/1/2023 →
  • Summary of Benefits and Coverage
    2022-2023 →
  • Summary of Benefits
    2022-2023 →
  • Summary of Benefits and Coverage
    2021-2022 →
  • Certificate of Coverage
    2021-2022 →
  • Summary of Benefits
    2021-2022 →
  • Non-Discrimination and Language Accessibility Notice
    Effective Oct. 2016 →
    • Additional Program Benefits
  • Recommended Immunizations for Children from 7 to 18 Years Old
    2023 →
  • Recommended Immunizations for Adults 19+
    2023 →
  • Recommended Immunizations for Children from Birth to 6 Years Old
    2023 →
  • FAQs Related to Coverage of At-Home COVID-19 Tests
    2/7/2022 →
  • Bright Futures Preventive Pediatric Health Care Recommendations
    Effective January 2022 →
  • Teladoc Telehealth Services
    →
  • Teladoc Telehealth Mental Health Services
    Effective January 2021 →
  • Health Benefits FAQ
    effective 1/1/2021 →
  • EyeMed Discount Program for Delta Dental Members
    →
    • Pharmacy Policies - General
  • Plan Formulary
    Effective 1/1/2023 →
    • Welcome to Viva
  • Appointment of Representative
    Complaints Process →
  • Personal Representative Appointment Form
    →