Forms
- Authorization for Release of Protected Health Information (PHI) (PDF, 160 KB)
- Confidential Communication Request Form (PDF, 180 KB)
- Continuity of Care Assistance Request (PDF, 200 KB)
- Coordination of Benefits Form (PDF, 620 KB)
- GRIEVANCE FORM
- Member Claim Reimbursement Form (PDF, 340 KB)
- Prescription Drug Reimbursement Form
Benefit Information
- Consumer price transparency tool
- Doctor on Demand (PDF, 490 KB)
- Evidence of Coverage (PDF, 1.8 MB)
- Gym Membership Discounts
- Member Welcome Guide (PDF, 660 KB)
- Preferred Drug List (PDF, 200 KB)
- Prescription Drug Formulary (PDF, 7.4 MB)
- Provider Directory (PDF, 4.4 MB)
- Summary of Benefits (PDF, 410 KB)