Umpqua Health Members

Documents & Forms

If you can’t find what you’re looking for below, our Customer Care team can help.

Postal Prescription – Quick Reference Guide

Review this guide to find tips and answers to questions for medication by mail.

Machine-Readable Formulary

Machine-readable formulary data file (effective April 2026) for Umpqua Health Alliance’s Oregon Medicaid plan, listing covered medications with NDC codes, drug tier assignments, prior authorization requirements, step therapy, and quantity limits in a structured JSON format for interoperability.

UHA Comprehensive Formulary

Umpqua Health Alliance Formulary (Preferred Drug List) provides information on covered medications, coverage rules, and formulary status to help members and providers make informed pharmacy decisions.

NOABD FAQs (Spanish)

Encuentre respuestas a preguntas frecuentes sobre determinaciones adversas de beneficios.

NOABD FAQs

Find answers to frequently asked questions about adverse benefit determinations.

Appeals & Hearing Request (Spanish)

Utilice este formulario para enviar una solicitud de audiencia a la Autoridad de Salud de Oregón (OHA).

Appeals & Hearing Request

Use this form to submit a hearing request to the Oregon Health Authority (OHA).

UHA Complaint Form (Spanish)

Utilice este formulario para enviar una queja por escrito a Umpqua Health.

UHA Complaint Form

Use this form to submit a written complaint to Umpqua Health.

HRSN Nutrition Service Request Form

Use this form to request nutrition assistance services.

HRSN Housing Service Request Form

Use this form to request housing assistance services.

HRSN Home Changes For Health Request Form

Use this form to request a HRSN Home Changes For Health (such as an air conditioner or portable heater).