Commonly Used Forms & Resources

Below are commonly used forms and resources for your convenience.
 

Gym Reimbursement Form - Please read the instructions and complete this online form.

Appointment of Representative

Authorization to Receive or Release Medical Information

California Medicare Advantage Plan Member Appeals & Grievance

Request for Medicare Prescription Drug Coverage Determination

Request for Redetermination of Medicare Prescription Drug Denial

Medicare Complaint Form (by clicking this link , you will be redirected away from Inter Valley Health Plan's website.)

Ombudsman(by clicking this link , you will be redirected away from Inter Valley Health Plan's website.)

Advanced Health Care Directive Form:  English or Spanish