Download and print the health plan form you need.
Authorization for the Release of Protected Health Information
Appointment of Representation Form
Direct Member Reimbursement Form
OptumRx New Prescription Mail In Order Form
Express Scripts Home Delivery Order Form
Walgreens Mail Order Service Form
Coverage Determination Form
Coverage Redetermination Form
CMS Determination Form
CMS Medicare Complaint Form
Payment Option Form
If you don’t see the form you’re looking for, call the toll-free Customer Service number on the back of your member ID card.