Helpful Resources

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Plan Information

Product Brochure
Provider Directory
Summary of Benefits
Evidence of Coverage

Prescription Drug and Pharmacy Information

Formulary Guide
Drug Information
Top 100 Drugs
Medication Therapy Management (MTM) Program
Medication Therapy Management (MTM) Medication List

Other important programs, forms and policies

Diabetes Prevention Program (MDPP)
LIS Premium Summary Chart
Non-Discrimination Policy
PHI Authorization Request Form
Policies & Procedures
Appointment of Representative (AOR) Form

Enrollment Forms

Enrollment Form
Authorization for Automatic Bank Draft
Important Legal Information

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