Ensure your coverage gets off to a smooth start.
Please complete and return these forms promptly to help ensure the best experience when using your health plan.
Key plan forms and resources.
Permission to Speak with Others [PDF]
Use this form to let us discuss your health care with family members, caregivers, or others you choose. You may include power of attorney documentation with this form.
Appointment of Representative [PDF]
Use this form to appoint someone to act on your behalf for a claim, appeal, grievance, or request. This form is valid for 365 days from the date we receive it.
VA Health Coverage [PDF]
If you also receive health benefits through the Veterans Administration, complete and return this form so we can coordinate your coverage information.
Continuity of Care Letter [PDF]
Read this letter to learn how the Continuity of Care program may help prevent interruptions in care if you are receiving ongoing medical treatment.
Continuity of Care Form [PDF]
If you are receiving ongoing medical treatment, complete and return this form so we can review whether Continuity of Care applies to your situation.
CVS/Caremark Mail-Order Prescriptions [PDF]
If your plan includes Part D prescription drug coverage, use this form to request eligible prescriptions by mail through CVS Caremark.
Find more important documents, including the ones listed above, on our Member Resources Page.
Plan Resources
Explore our most commonly used resources when getting started on your plan.