Management/Non-Represented Plan Design Retirees
| Forms | Description | Access Information |
|---|---|---|
Enhanced Point of Service (POS) Option/Standard 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 Behavioral 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 Service Order Forms |
Required when mailing your initial request for filling up to a 90-day supply of medications through CVS Caremark Mail Service Pharmacy |
CVS Caremark: |
Aetna Dental Plan Claim Forms (Aetna Dental Plan Dental Preferred Provider Organization [PPO] option participants) |
Required only if you use a dentist outside of the Aetna network |
Aetna: |
