Below is a listing of plan forms, brochures and documents to help you manage and understand your benefits.
Member Forms & Documents
| Title | Download |
|---|---|
| 2022 – Official Plan Brochure | |
| 2022 – Summary of Benefits | |
| 2022 – Medicare Plan Brochure | |
| 2022 – Medicare Summary of Benefits Guide | |
| 2022 New Member Guide | |
| 2021 – Official Plan Brochure | |
| 2021 Know Where to Go Guide | |
| 2021 Making the Most Out of Your Plan | |
| 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) |