Request Materials by Mail

For the most up-to-date information, you can find a provider, pharmacy and drug online, as well as your Evidence of Coverage booklet:

To have a printed copy mailed to you, please fill out the form below. All fields are required unless otherwise noted.

First Name*

Last Name*

Middle Initial

Street Address*

Apartment/Building/Suite

City*

State Code*

Zip Code*

Phone Number

Select Plan Year*

Pharmacy Directory

Drug Formulary

Evidence of Coverage

Requesting this information does not obligate you to enroll nor allow Alignment Health Plan to enroll you in one of our health plans.

Page last updated on September 30, 2024 | Y0141_25277EN_M