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Resources for Individual & Family Plans

Find more information about benefits, claims, and coverage here.

Plan Info Plan Documents

Benefits

Member Claim Form

Member Handbook Sample

Pharmacy Claim Form

Referral Form

Written Plan Description

Legal Forms & Notices

Coordination of Benefits (COB) Form

How to Submit a Pre-Authorization

Interoperability and Patient Access

Medical Power of Attorney

Minor Dependent PHI Access

Nondiscrimination and Languages/Accessibility

Pharmacy Pre-Authorization Form

Pre-Authorization Form

Pre-Authorization List of Codes

Transition and Continuity of Care Member Guide

Transition and Continuity of Care Patient Request Form

Have more questions?

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Mon - Fri, 8am - 5pm CT

(855) 481-0225