Group Forms
Other Forms
- Appoint a Representative - authorize someone to act on your behalf
- Common Ownership Verification
- Continuation of Coverage Form
- Healthy Lifestyle Rebate Form
- Participation Validation
Pharmacy / Medical Orders & Authorizations
- Medical Authorization Request Form - must be completed and submitted by your physician
- Medical Reimbursement Form
- Request for Commercial Prescription Drug Coverage Decision - must be completed and submitted by your physician
- Prescription Drug Reimbursement Form
General Information
- Covered Preventive Services
- Fitness Membership (Active&Fit)
- Health Education Programs
- Agency for Health Care Administration
- Member Rights and Responsibilities
- Notice of Privacy Practices
- Provider Directory
- Transparency in Coverage
- Urgent Care
- More About our Secure Web Site