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Advance Directive
What is an Advance Directive?
Advance Directive Form
Your Right to Decide: Communicating Your Healthcare Choices Brochure
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Claims
Instructions on How to File a Claim
Out-of-Network Vision Claim Form
Patient's Request for Medical Payment Form (Medicare)
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Coordination of Benefits
Coordination of Benefits Form
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Complaints and Member Appeals
Resolving Complaints and Appeals
Member Appeals Packet
Member Complaints Packet
Member Complaints Packet (Family Care Members)
Optima Medicare: Grievance, Coverage Determination and Appeals Process for Parts C and D
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Drug Lists
Preferred, Standard and Premium Drug List
Prior Authorization, Step-Edit and Quantity Limits Drug List
Pharmacy packaging limits have been removed from most drugs, allowing you to get a full month supply for a single copay View the list above for drugs that continue to have a quantity limit.
Generics Plus Formulary
Medicare Drug Authorization Forms
Exception Form
2009 Optima Medicare Drug List
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Pharmacy Mail Order
Instructions for Mail Order Pharmacy
Caremark Mail Service Form
CVS Caremark MEDICARE Part D Confidential Mail Service Enrollment Form
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Pharmacy Reimbursement
Instructions for Pharmacy Reimbursment
Direct Member Reimbursement Form
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Pre-Existing Condition Letter
Pre-Existing Condition Letter
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Authorizations for Release of Medical Information
Authorization for Use or Disclosure of Medical Information
What is the Authorization for Use or Disclosure of Information
Designated Representative Authorization Form
Designated Agent Form
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Student Verification
Student Verification Form
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Transitional Care
Transitional Care Request Form
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