FORMERLY REPRESENTED RETIREES
| Forms | Description | Access Information |
|---|---|---|
Point of Service (POS) Option Claim Forms |
Complete a form only if you utilize out-of-network providers (in-network providers typically submit claims directly to the carrier) |
UnitedHealthcare: |
Traditional Indemnity (TI) Option Claim Forms |
Complete a form when you need to utilize medical benefits |
UnitedHealthcare: |
Mental Health and Chemical Dependency Coverage Precertification Forms |
Check with your carrier before receiving treatment to confirm whether you need to complete a precertification form |
UnitedHealthcare Mental Health and Chemical Dependency |
Prescription Drug Program Claim Forms |
Required when you need to use a pharmacy outside of the CVS Caremark network |
CVS Caremark: |
Prescription Mail |
Required when mailing your initial request for filling up to a 90-day supply of medications through CVS Caremark Mail Service Pharmacy |
CVS Caremark Mail Service Pharmacy: |
Aetna Dental Plan Claim Forms |
Required only if you use a dentist outside of the Aetna network |
Aetna: |
