Details about our plans are included in the information below.

• Summary of Benefits (235 KB PDF)
  

• Evidence of Coverage
• Useful Telephone Numbers
• Enrollment Guidelines
• Forms
• Formulary Search

• Pharmacy Directory (139 KB PDF)
  
• Out-of-Network Pharmacy Description (89 KB PDF)
  
• Low-Income Subsidy Table (70 KB PDF)
  
• Drug Transition Policy (What if my drug is not on the formulary?) (66 KB PDF)
  
• Appeals & Exceptions (234 KB PDF)
  
• Medication Therapy Management (98 KB PDF)
  
• Medication Therapy Management Newsletter - 1st Quarter (462 KB PDF)
  
• Medication Therapy Management Newsletter - 2nd Quarter (1651 KB PDF)
  
• Rights & Responsibilities Upon Disenrollment (28 KB PDF)
  
• Report Fraud and Abuse
  
• Privacy Notice (21 KB PDF)
  

• Disclaimers