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Piedmont Customer Service
(434) 947-4463, (800) 400-PCHP

 

Plan Guides / Documents

Here on the Piedmont documents webpage, we have grouped together PDF file links to our Plan Guides and other relevant documents for your convenience.  Please click-on any of the below links to view these informative materials.

diamond  Individual PPO Marketplace Plan Guide 2017

diamond  Individual HMO Marketplace Plan Guide 2017

diamond  Individual PPO Marketplace Plan Guide 2016

diamond  Individual HMO Markeplace Plan Guide 2016

 

diamond  Individual Marketplace Plans PPO "Policy Booklet" 2017

diamond  Individual Marketplace Plans HMO "Policy Booklet" 2017

diamond   Individual Marketplace Plans PPO "Policy Booklet" 2016

diamond   Individual Marketplace Plans HMO "Policy Booklet" 2016

     

For a listing of each plan's copayments and deductibles

diamond  2017 Individual Marketplace Plans "Schedule of Benefits" tables PPO

diamond  2017 Individual Marketplace Plans "Schedule of Benefits" tables HMO

diamond  2016 Individual Marketplace Plans "Schedule of Benefits" tables PPO

diamond  2016 Individual Marketplace Plans "Schedule of Benefits" tables HMO

     

diamond  2017 Individual Marketplace Plans "Summary of Benefits and Coverage (SBCs)" PPO

diamond  2017 Individual Marketplace Plans "Summary of Benefits and Coverage (SBCs)" HMO

diamond  2016 Individual Marketplace Plans "Summary of Benefits and Coverage (SBCs)" PPO

diamond  2016 Individual Marketplace Plans "Summary of Benefits and Coverage (SBCs)" HMO

 

diamond    Primary Care Physician Designation Form for HMO Plans

diamond    Dependent Out of Network Form

diamond    Federal Glossary of Healthcare Terms

diamond    Release of Confidential Information Form

diamond   Transition of Care Form PPO

diamond   Transition of Care Form HMO

 diamond  Medical Claim Form

 

Appeal Request

diamond  Appeal Request Form