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 PDF
Summary of Benefits – 2021 PDF
2021 RCBP Medicare Brochure PDF
2021 Know Where to Go Guide PDF
2021 Making the Most Out of Your Plan PDF
2021 New Member Guide PDF
Prescription Drug Guide/Formulary PDF
Prescription Drug Guide – Specialty Drugs PDF
Prescription Drug Guide – All Other Drugs PDF
Specialty Quantity Limit Program – Drug List PDF
Performance Drug List PDF
Performance Drug List Change Summary PDF
Claim Form – Medical PDF
Claim Form – Mail Order Prescription PDF
Claim Form – Prescription, Retail Pharmacy PDF
Claim Form – Wellness Incentive PDF
Provider Nomination Form PDF
Authorization for Release of Protected Health Information (PHI) PDF