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) |