Below are official plan documents you may need to properly understand or receive benefits under your plan.
Title | Download |
---|---|
Claim Form - Medical | |
Claim Form - Prescription, Retail Pharmacy | |
Claim Form - Mail Order Prescription | |
Claim Form – Wellness Incentive | |
Summary of Benefits - 2018 | |
Official Plan Brochure - 2018 | |
Prescription Drug Guide - All Other Drugs | |
Prescription Drug Guide - Specialty Drugs | |
Prescription Drug Guide/Formulary | |
Provider Nomination Form | |
Authorization for Release of Protected Health Information (PHI) |