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Forms and Applications

The following materials can be downloaded and printed using Adobe Acrobat Reader, which is available free. Additional forms and information will be added as they become available.

Name	Links
Annual Notice of Change	(not yet available)
Appointment of Representative	64KB, 2 pgs.
Evidence of Coverage	780KB, 128 pgs.
Medical Claim Form	80KB, 2 pgs.
Member Handbook	2.0 MB, 20 pgs.
Member Handbook (Optimized for Screen Reader Usability, JAWS)	4.26 MB, 20 pgs.
Pharmacy Directory	352KB, 80 pgs.
Pharmacy Directory (Optimized for Screen Reader Usability, JAWS)	14.6MB, 80 pgs.
Prescription Drug Claim Form	62.4KB, 2 pgs.
Prescription Drug Coverage Determination Form	72KB, 2 pgs.
Prescription Drug Transition Notice	744KB, 2 pgs.
Privacy Practices	93KB, 10 pgs.

PDF Viewing & printing this form requires Adobe Acrobat Reader, which can be downloaded free from the Adobe site.

News

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Health and Wellness Information

Foods That Help You
LOSE WEIGHT

Low-calorie, high-fiber foods such as fruits and vegetables fill you up but don't add that much to your daily calorie total.

Click here for more health and wellness info

Options
Discount Program

Options Discount Program takes you in healthy directions by opening the door to discounts on a broad range of alternative therapies and wellness services.

Click here for more info