Forms and Resources

The following listings are forms and resources you may need as a member of the Alliance. If you need help, call the Alliance Member Services Department at (800) 700-3874.



Notice of Privacy Forms


Personal Representative Request


Authorization to Use or Disclose Protected Health Information


Member Reimbursement Claim Form


Other Health Coverage (OHC)

If you have Medi-Cal and other health insurance, you will need to update your information with your local county either by phone or online.


To update by phone:

Merced County
209-385-3000
Monterey County
877-410-8823
Santa Cruz County
888-421-8080

To update on the California Department of Health Care Services (DHCS) website:

https://www.dhcs.ca.gov/services/Pages/TPLRD_OCU_cont.aspx




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