2019 Individual plan documents

Plan documents for 2020

Plan & coverage  go back

Prescriptions & payments  go back

Drug claims & alternatives  go back

  • Coverage determinations (Prior authorization or exceptions)
    Use these forms to request a coverage decision (sometimes called a prior authorization or exception) for a drug in your treatment plan when your health care provider or pharmacist tells you that we will not cover the prescription. Read additional information or use the online form or printable form if this is your first coverage request for a drug.
  • Redetermination
    Use the online form or printable form if you are appealing a previously denied request.

Medication policies and programs  go back

Representative & confidential information go back

General information go back