Community Meeting Request Form 
Paper Claim Form for Medicare members
Paper Claim Form for Non Medicare members
Mail Order Prescription Form for members only
Prescription Advantage Non Medicare Fact Sheet 
Prescription Advantage Medicare Fact Sheet
Instructions for Online Application Only
Non Medicare Prescription Value Guide
Prescription Advantage Disability Status Documentation
Prescription Advantage Income Documentation
Self-Attestation New Applicant
Self-Attestation Income to be Added
Self-Attestation Income Changes Existing Member
Prescription Advantage Rate Schedule Guide for Members Eligible for Medicare
Prescription Advantage Rate Schedule Guide for Members Not Eligible for Medicare
Representative Authorization Forms
(ES) Instructions for Online Application – Spanish
(ES) Prescription Advantage Application Form – Spanish
(ES) Prescription Advantage Schedule Guide – Spanish
Please note: If you need assistance with any of these documents in any other language, please call our customer service line at 800-243-4636 for translation assistance.