Forms + Documents
Welcome to Our Members' Resource Center
Our Members' Resource Center provides a central location for all of the important forms and documents you need to manage your health and your health plan.
Information for Tax Filings
Your Secure Online Account
- Prior Authorization of Certain Procedures
- Medical Necessity Guidelines: Used to determine coverage for services requiring prior authorization.
- Pharmacy Medical Necessity Guidelines: Used to determine coverage for drugs requiring prior authorization.
- CVS Prescription Claim Form
- CVS Prescription Mail Order Form
- Eye Care Benefits
- Pharmacy Brochure
- Preventive Medications
- Appointment of Personal Representative Form
- Authorization to Disclose Personal Health Information
- Claims Profile Request Form
- Disabled Dependent Evaluation Form
- Member Non-Formulary Pharmacy Request Form
- Out-of-Network Vision Services Claim Form
- Prenatal Questionnaire
- Reimbursement Medical Claim Form
- Verification of Alternative Coverage