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Client Services > Group Benefits Plan Members > Forms > Prior Authorizations Forms

Prior Authorization Forms

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Certain prescription drug claims need to be approved before we can consider reimbursement.

If your group benefits plan covers the drug you’re being prescribed and you want to be considered for coverage:

1. Select the Request for Information form, listed by drug name.

2. Print the form.

3. Ask your attending physician to complete it.

4. Send the completed form to us by mail or fax.

Request for Information forms

To find the appropriate form, select the first letter of the drug you’re being prescribed.

A    B    C    D    E    F    G    H    I    J    K    L    M    N    O    P    R    S    T    U    V    X    Y    Z


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Questions?

Contact your plan administrator, or go to our Contact Information – Coverage and Claims Status page.

Need to Make Changes?

To update your personal information, contact your plan administrator.