Member Forms

  • Accident and Injury Form

  • Coordination of Benefits

  • Authorization for Release

  • Application for Disabled Dependent

  • Provider Request for Prescription Form

  • Request for Certificate of Credible Coverage

    To download these forms, you will need Adobe Acrobat Reader (for PDF files). If you do not have Adobe software, please visit the following website to download a free version of Adobe Acrobat Reader:


    We will be undergoing a major software upgrade starting on 5/5/17 that will affect our ability to provide you online access to claims and enrollment records from 4/28/17 on.

    Members will continue to receive mailed documents, and you may continue to log into this website to view records prior to 4/28/17.

    Online access to your records will resume on 10/20/17. Thank you for your patience.



    Disclaimer    Privacy Policy    HIPAA Statement

    All text material on this web site is the property of South Central Preferred.  Any reproduction or redistribution of this material is prohibited without the express written consent of South Central Preferred. Reproduction or redistribution of photographs or illustrations appearing on this web site is strictly prohibited.

    Medical necessity review criteria used by the Medical Management department of WellSpan Population Health Services/South Central Preferred are available by calling the Medical Management department, 717-851-6801 or 800-888-1929. The criteria will be sent to you by mail, fax or e mail.