Plan Details and Documents

Looking for plan details and documents? To get started, use the following links “Quick Links” to access helpful plan details and documents:

• Plan Benefit Materials  –access plan documents including your Annual Notice of Change, Summary of Benefits, and Evidence of Coverage.
• Find a Doctor or Pharmacy – access Provider Directories or find a doctor or pharmacy using our search tool. 
• List of Drugs (Formulary)  – if you have a Medicare Advantage Prescription Drug plan, access your plan’s Drug List (Formulary) and search tool.
• Member Perks – learn about member perks such as telehealth, dental, and over-the-counter benefits. 
• Disaster Coverage – learn how to access coverage in the event of a disaster or local emergency.
• Appointment of Representative Form – use this form to appoint a representative on your behalf. 
• Prescription Drug Claim Form – if you have a Medicare Advantage Prescription Drug plan, use this form when you need to ask us to pay you back for prescriptions paid out-of-pocket.
• Member Reimbursement Claim Form – use this form when you need to be reimbursed for eligible out-of-pocket medical expenses.
• Real Time Benefit Tool – to access the Real Time Benefit tool, login to the secure member portal.  If you don’t have an account, select “Create New Account” and follow the prompts.  
• Member Forms - additional member forms for your needs.