UPMC Health Plan
Members
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HealthChoices
HealthChoices
Members

Member Forms

Member Forms
The following files are in PDF format. In order to read these files, Adobe Acrobat Reader software must be installed on your computer. If you need the Acrobat Reader, you can download it FREE from the Adobe website by clicking here. If you have any problems opening these files, go to the Adobe website from the link above and download the most recent version of Adobe Acrobat Reader.
Request for Access to Protected Health Information 37 KB 1 page PDF
Request for Access to Protected Health Information (espanol) 100 KB 1 page PDF