Below is a listing of plan forms, brochures and documents to help you manage and understand your benefits.
Member Forms & Documents
Title | Download |
---|---|
Official Plan Brochure – 2021 | |
Summary of Benefits – 2021 | |
2021 RCBP Medicare Brochure | |
Prescription Drug Guide/Formulary | |
Prescription Drug Guide – Specialty Drugs | |
Prescription Drug Guide – All Other Drugs | |
Specialty Quantity Limit Program – Drug List | |
Performance Drug List | |
Performance Drug List Change Summary | |
Claim Form – Medical | |
Claim Form – Mail Order Prescription | |
Claim Form – Prescription, Retail Pharmacy | |
Claim Form – Wellness Incentive | |
Provider Nomination Form | |
Authorization for Release of Protected Health Information (PHI) |