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Flexible Choice

Documents and Forms

Looking for information about you Flexible Choice plan? View, download, or print commonly used forms, FAQs, reference guides, and other documents here.

Links to important forms and documents.

Provider Options by Location:

Kaiser Permanente States: The PHCS and Multiplan Networks provides access to care in the Kaiser Permanente states of CA, CO, GA, HI, MD, OR, VA, WA, and DC.

Non-Kaiser Permanente States: The CignaPPONetwork* only provides access to care in non-Kaiser Permanente states

*Disclaimer: The Cigna PPO Network refers to providers (doctors, hospitals, specialists) contracted as part of the Cigna PPO for Shared Administration.

Quick Documents

Flexible Choice and Out-of-Area PPO Formulary

Precertification Request Form

Medical Claim Form

Pharmacy Claim Form

Nominate a PHCS and/or MultiPlan Provider

Member Care Transition Form

Flexible Choice Information for Physicians

Prepare for Your non-KP Appointment Flyer

Your Rights and Protection Against Surprise Medical Bills – Maryland

Your Rights and Protection Against Surprise Medical Bills – District of Columbia

Your Rights and Protection Against Surprise Medical Bills – Virginia

Flexible Choice Reference Guide

Flexible Choice Overview Flyer

Deductible Flex Choice Reference Guide

Deductible Flex Choice Flyer

HSA Qualified Flex Choice Reference Guide

HSA Qualified Flyer