Forms
- Appointment of Personal Representative
- Authorization to Use and Disclose PHI
- Care Management Referral
- Commercial Dependent Eligibility Beyond Limiting Age
- Commercial Products Member Complaint and Appeal
- Coordination of Benefits
- Emancipated Minor Restriction of Claims Access
- Member Reimbursement (DHHA)
- Pharmacy Prior Authorization Request (PAR)/Exception Request
- Subscriber Access to Spouse or Adult Dependent Claims
- Transition of Care Request/Continuation of Care Request
Documents
Links
- Affirmative Statement About Incentives
- Continuous Glucose Monitor Usage
- Emergency / Non-Emergency Out-of-network Disclosure
- Essential Health Benefits
- Glossary
- Member Portal
- Member Rights & Responsibilities
- Price Transparency
- US Preventive Services Taskforce Recommendations
- Women's Preventive Services Guidelines