Text:

View My Coverage and Benefits


Plan Documents

Select the name of the plan you are enrolled in to view your plan-specific documents — Summary of Benefits, Evidence of Coverage. You can find your plan name on your member ID card.


Provider Directory: 2024 Provider/Pharmacy Directory (last updated 12/06/2024)

Pharmacy Documents

2024 Formulary (last updated 12/01/2024)

2024 Prior Authorization Criteria (last updated 12/01/2024)

2024 Prior Authorization Forms

Last updated: 01/2025