Please take a look at these important Member forms:

• Automatic Check (ACH) Premium Payment (PDF)
• Physician Fax Form (PDF)
• Prescription Drug Claim Form (PDF)
• Walgreens Mail Registration & Prescription Order Form (PDF)

 

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• Summary of Benefits (PDF) 
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• Terms & Conditions
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• Privacy Notice (PDF)
• About Medicare Part D
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• CMS.gov*
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