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Plan Resources

Information Last Updated: 6/24/2021

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Quarterly Newsletters

Winter Newsletters (English | Spanish | Chinese | Korean | Vietnamese)

Spring Newsletters (English | Spanish | Chinese | Korean | Vietnamese)

Summer Newsletters (English | Spanish | Chinese | Korean | Vietnamese)

 

Forms

2021 Over-the-Counter (OTC) Order Form
(English | Spanish | Chinese | Korean | Vietnamese)

2021 Appeal Form
(English | Spanish | Chinese | Korean | Vietnamese)

Appointment of Representative Form (English | Spanish)

Authorization for Disclosure of Protected Health Information

Enrollment Form (2021)

2021 Grievance Form
(English | Spanish | Chinese | Korean | Vietnamese)

Authorization Service Request Form (English | Spanish)

Benefit Highlights

Health Risk Assessment (HRA)
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To complete an Electronic HRA click here

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