Official RCBP plan documents
Plan brochures, forms and documents to help you with your benefits.
All available documents are clickable below. If an item is not clickable, it is not available at this time.
Member plan brochures
- 2025 Official Plan Brochure. Opens in a new window - PDF
- 2025 Benefit Summary Brochure. Opens in a new window - PDF
- 2025 Medicare Brochure. Opens in a new window - PDF
- 2025 RCBP SBC. Opens in a new window - PDF
- 2025 RCBP New Member Guide. Opens in a new window - PDF
- 2025 Making the Most of RCBP Brochure. Opens in a new window - PDF
Retiree documents
- 2025 Aetna Medicare Advantage Plan Brochure. Opens in a new window - PDF
- 2025 Aetna Medicare Advantage Plan for RCBP Summary of Benefits. Opens in a new window - PDF
- 2025 Evidence of Coverage. Opens in a new window - PDF
- 2025 Plan Document Notice. Opens in a new window - PDF
- 2025 Schedule of Cost Sharing. Opens in a new window - PDF
- RCBP Medicare Advantage Information for Your Provider. Opens in a new window - PDF
Retiree prescription drug information
- 2025 5 Tier Comprehensive Plus Formulary. Opens in a new window - PDF
- 2025 Prior Authorization Information. Opens in a new window - PDF
- 2025 Step Therapy Information. Opens in a new window - PDF
- 2025 Drug List Changes. Opens in a new window - PDF
- 2025 Non-Part D Supplemental Benefit. Opens in a new window - PDF
- 2025 Essential Health Supplemental Benefit. Opens in a new window - PDF
Active employee prescription drug information
- 2025 Prescription Drug Guide/Formulary
- 2025 Prescription Drug Guide – Specialty Drugs
Claim forms
- CVS/Caremark prescription reimbursement claim form PDF - opens in a new window
- Dental claim form (MHBP Dental plan only) PDF - opens in a new window
- Medical claim form PDF - opens in a new window
- Overseas Medical claim form PDF - opens in a new window
- Wellness Incentive claim form PDF - opens in a new window
Member forms
Note: Once your disenrollment is effective, you will no longer have prescription drug coverage under your RCBP High Option PSHB plan. Prior to disenrolling, please call Member Services at 1-866-241-0262 (TTY: 711).
- Learn more about contraception resources at OPM’s webpage. Opens in a new window.
- Please contact OPM if you have difficulty accessing contraceptive coverage or other reproductive health by contacting contraception@opm.gov.
- For additional information members can learn more about their reproductive rights at HHS website. Opens in a new window.
- Coordination of Benefits form PDF - opens in a new window
- CVS/Caremark prescription mail service order form PDF - opens in a new window
- Consumer Option HRA Reimbursement request PDF - opens in a new window
- Consumer Option HSA Transfer form PDF - opens in a new window
- Consumer Option HSA Excess contribution form PDF - opens in a new window
- Health Savings Account (HSA) Custodial agreement PDF - opens in a new window
- Health Savings Account (HSA) Fee schedule PDF - opens in a new window
- MHBP Brand Exception form PDF - opens in a new window
- Utah Network selection form PDF - opens in a new window
- Authorization for release of protected health information (PHI) PDF - opens in a new window
- Contraceptive management exception form PDF - opens in a new window
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