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Plan Resources

Plan Resources

Information Last Updated:1/13/2023

Quarterly Newsletters

Winter Newsletters (English | Spanish | Chinese | Korean | Vietnamese)

Spring Newsletters (English | Spanish | Chinese | Korean | Vietnamese)

Summer Newsletters (English | Spanish | Chinese | Korean | Vietnamese)

Fall Newsletter (English | Spanish | Chinese | Korean | Vietnamese)

Forms

Over-the-Counter (OTC) Order Form (2023) (English)

Appeal Form
(English | Spanish | Chinese | Korean | Vietnamese)

Appointment of Representative Form (English | Spanish)

Authorization for Disclosure of Protected Health Information

Enrollment Forms (2023)

Express Scripts Direct Order Forms
(English | Spanish)

Grievance Form
(English | Spanish | Chinese | Korean | Vietnamese)

Authorization Service Request Form (English | Spanish)

Benefit Highlights

2023 Health Risk Assessment (HRA)
(English | Spanish | Chinese | Korean | Vietnamese)

To complete an Electronic HRA click here

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