Member Service
Formulary Drug Listing:
Prior Authorization Drug Listing:
Preferred Drug List:
Specific Drug Listings for California group contracts:
Specific Drug Listings for Illinois group contracts:
- Drug List/Formulary 2024 IL
- Drug List/Formulary 2025 IL
- Prior Authorization and Specialty RX Guidelines – 2024 IL
- Prior Authorization and Specialty RX Guidelines – 2025 IL
- Notice of Changes – 2024 IL
- Notice of Changes – 2025 IL
Specific Drug Listings for New Jersey group contracts:
Specific Drug Listings for New York group contracts:
- New York (NY) - Weight Loss Medications
Prescription weight loss medications are eligible for coverage. Please note, specific criteria will apply for Prior Authorization (PA) requirements related to weight loss medications. This change is allowed for all NY clients and membership regardless of the individual client's renewal dates. Updated documents will be posted shortly. - Drug List/Formulary – Q4 2023 NY – For all renewals prior to 4/1/2024
- Drug List/Formulary – Q2 2024 NY – For groups with renewal dates of 4/1/2024, 5/1/2024 and 6/1/2024
- Drug List/Formulary – Q3 2024 NY – For groups with renewal dates of 7/1/2024, 8/1/2024 and 9/1/2024
- Drug List/Formulary – Q4 2024 NY – For groups with renewal dates of 10/1/2024, 11/1/2024 and 12/1/2024
- Drug List/Formulary – Q1 2025 NY – For groups with renewal dates of 1/1/2025 and later
Specific Drug Listings for Texas group contracts:
2025
Available upon each group’s 2025 renewal- Drug List/Formulary – 2025 TX
- Prior Authorization and Specialty RX Guidelines – 2025 TX
- Notice of Changes – 2025 TX
- Prior Authorization Request Form for Prescription Drug Benefits - TX
2024
Available upon each group’s 2024 renewal- Drug List/Formulary – 2024 TX
- Prior Authorization and Specialty RX Guidelines – 2024 TX
- Notice of Changes – 2024 TX
- Prior Authorization Request Form for Prescription Drug Benefits - TX
2023
Available prior to group’s 2024 renewal- Important Information for Medical Office Staff (ASA only)
- Important Information for Dental Office Staff (ADA only)
- Precertification
- Claim forms: Looking for a claim form? You may print or download one of the following forms to use.
Standard Claim Forms
Medical
Dental
Vision
Life
Disability
Want to look up the status of a claim? Or review your benefits? Register and log in to our member portal to have immediate access to all of the information you need about your insurance coverages.