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MEMBER RESOURCES > PLAN DOCUMENTS
Everything you need to understand your coverage.
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Plan Resources
Over-the-Counter (OTC) Health Products (Non-Skilled Nursing Facilities)
Services that Require Prior Authorization
Provider Directory for Advantage Care (HMO)
Part D Resources
Part D Drug Step Therapy Criteria
Part D Prior Authorization Criteria
Prescription Drug Determination Request
Prescription Drug Determination Request (Español)
Prescription Drug Redetermination Request
Prescription Drug Redetermination Request (Español)
Prescription Drug Claim Form
Costco Mail Order Form
Costco Sign Up Tutorial
Part D Benefit Guide
Policies and Forms
Standards of Conduct
Notice of Privacy Practices
CMS Appointment of Representative (CMS Form-1969)
Medicare Complaint Form
Medical Reimbursement (DMR) Form
If you would like to request a hard copy of the Provider or Pharmacy Directory call Member Services.
Requested paper directories will be mailed to you within 3 business days.
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