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To ensure you're able to submit forms easily to us or your employer, we've made some of our forms fillable. If you see "fillable" written after a form name below, you guessed it—that means it's fillable!
While some forms you'll be able to complete and submit fully electronically, others may still require a physical signature, so be sure to read the instructions for each.
Drug Special Authorization Forms
All special authorization forms must be completed and signed by an authorized health care provider (e.g., physician, nurse practitioner, dentist, etc.). Find these forms online. If you have questions, contact a benefit specialist at 1-877-438-4545 or email firstname.lastname@example.org.