Choices Select (HMO-POS)

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Documents and Forms

The following documents provide detailed information on Choices Select (HMO-POS) benefits and plan design. Use the links below to view Choices Select (HMO-POS) documents directly from your computer.

If you would like any of these documents mailed to you, please complete the form below. Be sure to select the documents you would like us to send to you. You should receive the documents within two weeks of your request.

2010 Documents

2010 Abridged Formulary (PDF file - 1.2 MB) - a partial list of the open formulary for prescription drugs.

2010 Provider Directory (PDF file - 5.5 MB)

2010 Evidence of Coverage (PDF file - 6.1 MB) - provides information about your benefits, membership, covered and non-covered services, member rights and responsibilities and other important plan details.

2010 Summary of Benefits (PDF file - 664 KB) - provides a general summary of benefits and services for each of our health plans.

Notice of Privacy Practices (PDF file - 588 KB) - describes how your medical information may be used and disclosed and how you can get access to this information.

Medicare Part D Tiering or Formulary Exception Request
(PDF file - 28KB)

Viewing these documents requires the Adobe Acrobat Reader, which can be downloaded for free.

If you would like any of these documents mailed to you, please complete the form below.

First Name:

Last Name:

Street Address:

City:

State:

Zip Code:

Date of Birth:

Telephone:

Member Number:

Choose the documents you wish to receive.

Abridged Formulary

Evidence of Coverage

Provider Directory

Summary of Benefits

Notice of Privacy Practices

Peoples Health Network is the administrator for Peoples Health, Inc.

Peoples Health is a Medicare Advantage organization with a Medicare contract.

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Last Update: January 05, 2010