Some of our most-requested forms are available for you to view and print online. Our downloadable forms require Adobe Reader in order to view and print -- get Adobe Reader.
What is an Advance Directive?
Advance Directive Form
Your Right to Decide: Communicating Your Healthcare Choices Brochure
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Access the collection of Broker Guides
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Coordination of Benefits Form
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Download Preferred, Standard and Premium Drug List
Prior Authorization, Step-Edit and Quantity Limits Drug List (Utilization Management List)
Access Drug Authorization Forms
Generics Plus Formulary (includes Individual and Family Health Plans)
Optima Health Injectable & Infusion Medication List
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HIPAA Agreement for Personal Health Information (PHI)
HIPAA Agreement
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Member Appeals Packet
Member Complaints Packet
Member Complaints Packet (Family Care Members)
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Out-of-Area Dependent
Out-of-Area Dependent Form
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Instructions for Mail Order Pharmacy
Caremark Mail Service Form
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Instructions for Pharmacy Reimbursment
Direct Member Reimbursement Form
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Release of Information (ROI)
Designated Agent Form (formerly called ROI)
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Student Verification Form
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Transitional Care Request Form
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Small Group Enrollment Applications
Small Group Member Enrollment Application
Virginia Small Employer Group Universal Enrollment Application
Large Group Enrollment Applications
Vantage Member Enrollment Application
Plus Member Enrollment Application
POS Member Enrollment Application
FourSight Member Enrollment Application
Equity Member Enrollment Application
Design Vantage Member Enrollment Application
Design POSA Member Enrollment Application
Design Plus Member Enrollment Application
Self Funded Member Enrollment Application
Health Savings Accounts (HSA) Enrollment Form
Optima Equity Health Savings Account (HSA) Enrollment Form
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Virginia Small Employer COBRA
COBRA 35% Letter
Optima Health ARRA Form (.xls)
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