Handbooks, Forms, and Resources
On this page, you can find copies of many WellKids by PA Health and Wellness resources, including documents, forms, and more. If you would like printed copies instead, please call our Member Services team at 1-855-445-1920 (TTY: 711).
2026 WellKids by PA Health and Wellness Member Handbook
Forms and Resources
- Authorization to Disclose PHI (PDF)
- Revocation of Authorization to Disclose PHI (PDF)
- Authorization to Disclose PHI (Spanish) (PDF)
- Non-Discrimination Notice
- Application Form (PDF)
- Renewal Form
- Income Guidelines Chart (PDF)
WellKids by PA Health and Wellness can provide vital documents and other information you need in other formats such as compact disc, Braille, large print, DVD, electronic communication and other formats if you need them, at no cost to you. Please contact Member Services at 1-855-445-1920 or 711 (TTY) to ask for any help you need. Depending on the information you need, it may take up to 5 business days for PHW to send you the information.