Forms and Documents

 

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

 Advance Directive Form

 Your Right to Decide: Communicating Your Healthcare Choices Brochure

 

Coordination of Benefits

 Coordination of Benefits Form

Drug Lists

 Preferred, Standard and Premium Drug List

 Prior Authorization, Step-Edit and Quantity Limits Drug List

 Generics Plus Formulary

Employer Sign In

 Confidentiality Agreement Form

 Portal User Profile Form

Member Appeals

 Member Appeals Packet

 Member Complaints Packet

 Member Complaints Packet (Family Care Members)

Out-of-Area Dependent 

 Out-of-Area Dependent Form

Pharmacy Mail Order

 Instructions for Mail Order Pharmacy
 Caremark Mail Service Form

Pharmacy Reimbursement

 Instructions for Pharmacy Reimbursment
 Direct Member Reimbursement Form

Release of Information (ROI)

 Release of Information Form

Student Verification

 Student Verification Form

Transitional Care 

 Transitional Care Request Form 

 

Last Updated June 06, 2008 12:44:44 PM