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.
Advance Directive
What is an Advance Directive?
Advance Directive Form
Your Right to Decide: Communicating Your Healthcare Choices Brochure
to top
Broker Guides
Broker Guide
Individual and Family Health Plans Broker Guide
Individual and Family Health Plans Broker Website Guide
to top
Coordination of Benefits
Coordination of Benefits Form
to top
Drug Lists
Download Preferred, Standard and Premium Drug List
Prior Authorization, Step-Edit and Quantity Limits Drug List
Generics Plus Formulary (includes Individual and Family Health Plans)
Medication Transition of Care Form
to top
HIPAA Agreement for Personal Health Information (PHI)
HIPAA Agreement
to top
Member Appeals
Member Appeals Packet
Member Complaints Packet
Member Complaints Packet (Family Care Members)
to top
Out-of-Area Dependent
Out-of-Area Dependent Form
to top
Pharmacy Mail Order
Instructions for Mail Order Pharmacy
Caremark Mail Service Form
to top
Pharmacy Reimbursement
Instructions for Pharmacy Reimbursment
Direct Member Reimbursement Form
to top
Release of Information (ROI)
Designated Agent Form (formerly called ROI)
to top
Student Verification
Student Verification Form
to top
Transitional Care
Transitional Care Request Form
to top