Documents & Forms Center

Agents, Employers, Members

Coordination of Benefits Instructions and Form

PDF icon Coordination of Benefits Instructions and Form.pdf

Agents, Employers, Medicare, Members, Providers

Covid OTC Test Kits

PDF icon COVID-OTC Test Kits.pdf

Members

COVID-19 Telehealth Flyer - SOF

PDF icon COVID-19 Telehealth Flyer.pdf

Agents, Employers, Members

Enrollment Application

PDF icon Enrollment Application 2017.042-FILLABLE.pdf

Members

Feeding Your Baby

PDF icon Feeding Your Baby.pdf

Members

FEHB Member Handbook - Effective 1-1-2022

PDF icon FEHB Member Handbook - Effective 1-1-2022.pdf

Members

General Pregnancy Information

PDF icon General Pregnancy Information.pdf

Agents, Employers, Members

General Reimbursement Request

PDF icon General Reimbursement Request.pdf

Agents, Employers, Members

Getting Care In A Disaster Area

PDF icon Getting Care In A Disaster Area.pdf

Agents, Employers, Members, Providers

Glossary of Health Coverage and Medical Terms

PDF icon Glossary of Health Coverage and Medical Terms.pdf

Agents, Employers, Medicare, Members, Providers

Health and Fitness Reimbursement Form

PDF icon Fitness Reimbursement Form 040820 FILLABLE.pdf

Agents, Employers, Members

LabCorp Frequently Asked Questions

PDF icon LabCorp FAQs.pdf

Agents, Employers, Members

LabCorp Locations

PDF icon LabCorp Locations.pdf

Members

Large Employer Member Handbook - Effective 10-1-2021+

PDF icon Large Employer Member Handbook - Effective 10-1-2021 Forward.pdf

Members

Large Employer Member Handbook - Effective 10-1-2021+

PDF icon Large Employer Member Handbook - Effective 10-1-2021 Forward.pdf

Members, Providers

Medical Services That Require Prior Auth

PDF icon MEDICAL SERVICES THAT REQUIRE PRIOR AUTHORIZATION 7-26-21.pdf

Medicare, Members

Medicare Prescription Drug Reimbursement Request

PDF icon MCR Prescription Drug Request for Reimbursement 2017 062617.pdf

Agents, Employers, Members

Member Status Change Form

PDF icon Member Status Change Form 2020.pdf

Members

Non-Group Conversion

PDF icon Non-Group Conversion.pdf

Members

Non-Medicare Appointment of Representation Form

PDF icon COM AOR form_3.11.15.pdf

Agents, Employers, Members

Non-Medicare Prescription Drug Reimbursement Request

PDF icon Non-Medicare Prescription Drug Reimbursement Request.pdf

Members

Patient Health Questionnaire

PDF icon Patient Health Questionnaire (PHQ-9).pdf

Agents, Employers, Members

Pregnancy And Coverage FAQ

PDF icon Pregnancy And Coverage FAQ.pdf

Members

QI Behavioral Health Program Description 2021

PDF icon PD-BH-QI-2021.pdf