Member Service

Formulary Drug Listing:

Prior Authorization Drug Listing:

Specific Drug Listings for California group contracts:

Specific Drug Listings for Illinois group contracts:

Specific Drug Listings for New Jersey group contracts:

• Drug List/Formulary Q1 2022

Specific Drug Listings for New York group contracts:

• Drug List/Formulary - 2022 NY

Specific Drug Listings for Texas group contracts:

• Prior Authorization Request Form for Prescription Drug Benefits - TX

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• Claim Payment Overview

• Precertification
• Claim forms: Looking for a claim form? You may print or download one of the following forms to use.
  
  

  Standard Claim Forms

  • CVS Caremark Prescription Reimbursement Claim Form
  • FSA Request for Reimbursement Form
  • Limited Purpose FSA Claim Form
  • HRA Claim Form
  • Member or Members Dependent Authorization for Disclosure of Health Information
  
  

  Medical

  • Medical Claim Form
  • Medical Claim Form - CA
  • Member or Members Dependent Authorization for Disclosure of Health Information
  
  

  Dental

  • Dental Claim Form
  • Dental Claim Form - CA
  • Dental Claim Form - NJ
  • Member or Members Dependent Authorization for Disclosure of Health Information
  
  

  Vision

  • Vision Claim Form
  • Vision Claim Form - CA
  • EyeMed Vision Care Out of Network Claim Form
  
  

  Life

  • Life Insurance Claim Form
  • Life Insurance Beneficiary Quick Reference Guide
  • Life Insurance Beneficiary Designation/Change Form
  • Life Insurance Community Property Consent Form
  • Life Insurance Affidavit
  
  

  Disability

  • Disability Claim Form
  • Continuance of Disability Form

Precertification Explained

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.

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