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
Claims
Instructions on How to File a Claim
Out-of-Network Vision Claim Form
Coordination of Benefits
Coordination of Benefits Form
Complaints and Member Appeals
Resolving Complaints and Appeals
Member Appeals Packet
Member Complaints Packet
Member Complaints Packet (Family Care Members)
Optima Medicare Appeal and Grievance Process
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
Pharmacy Mail Order
Instructions for Mail Order Pharmacy
Caremark Mail Service Form
Medicare Mail Service Form
Pharmacy Reimbursement
Instructions for Pharmacy Reimbursment
Direct Member Reimbursement Form
Pre-Existing Condition Letter
Pre-Existing Condition Letter
Release of Information (ROI)
What is the Release of Information
Designated Agent Form (formerly called ROI)
Student Verification
Student Verification Form
Transitional Care
Transitional Care Request Form