Group Business

Forms & Applications

Employer Application Master

Employee Application Form

Employee Change Form

Termination Form

Request for Waiver


Certification Disabled Dependent Maximum Age 2

Certification Disabled Dependent Maximum Age

Drug Formulary

Please check for any of the following abbreviations after the prescription you look up.

PA – Prior Authorization – the doctor will have to give authorization to get the medication approved
ST – Step Therapy - you may have to try a different medicine to treat your condition before your plan will cover the medicine your doctor first prescribed for you
QL – Quantity Limit - the pharmacy may only be allowed to give you exactly enough medicine to cover a certain period of time


This Link redirect you to a Quick Search that
allows you to search a doctor or facility by name.