Resources / Materials


  • 2018 List of Drugs (Formulary)…Coming Soon
  • Lista de medicamentos cubiertos para 2018 (Formulario)… Próximamente
  • 2018 Annual Notice of Change…Coming Soon
  • Aviso Anual de Cambios de 2018…Próximamente
  • 2018 Member Handbook…Coming Soon
  • Manual del Afiliado para 2018…Próximamente
  • Appeals Form…Coming Soon
  • Complaint Form…Coming Soon
  • Multi-Language Interpreter Services…Coming Soon
  • Prior Authorization Form…Coming Soon You cannot use this form for Medicare non-covered drugs. Non-covered drugs include but are not limited to fertility drugs, drugs given for weight loss, weight gain or hair growth, over-the-counter drugs, or prescription vitamins (except prenatal vitamins and fluoride preparations).
  • 2018 Summary of Benefits…Coming Soon
  • 2018 Resumen de Beneficios…Coming Soon
  • Find a Provider/Pharmacy
  • Hospice Prior Authorization Form
  • Prescription Drug Mail Order Form
  • Formo de pedido por correo de drogas de prescripción


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Last Updated: 05/04/2017