HealthPAC Resources

The following documents are provided in Portable Document Format (PDF) and require the free Adobe Reader.

For Everyone:

Brochure

• HealthPAC Brochure – English
• HealthPAC Brochure – Español

Participant Handbook

• HealthPAC Handbook – English
• HealthPAC Handbook – Español

For Providers

HealthPAC Contract Documents and Attachments – For Providers

• A-1 – HealthPAC PLAN: Eligibility, Applications, Enrollment, and Services (Effective: January 1, 2026)
  • • APPENDIX A – HealthPAC Division of Financial Responsibility
    • APPENDIX B – HealthPAC Federal Poverty Level and Liability Schedule
    • APPENDIX C – Guidelines for Determining Family Size
    • APPENDIX E – HealthPAC Verification Documents
    • APPENDIX F – HealthPAC Statement of Income and Residence

• A-2 – HealthPAC Provider Map
• A-4 – NET Transportation Policies and Procedures

• HealthPAC Formulary – Brand Names
• HealthPAC Formulary – Generic Names