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