- Drug claim form for Medicare Part D
Use this form to submit a claim for drugs you purchased that are covered by Medicare Part D. Learn how to complete the form.
- Appoint a representative
You can choose someone to file grievances, request coverage decisions and redeterminations on your behalf.
- Authorization to release information
You can give us permission to give your protected health information (PHI) to a person or organization on your behalf.
- Confidential communication request
You can request to have member communications, including claims-related information, mailed to a different address than your permanent address.
- Our privacy practices
Learn how information about you may be used and disclosed and how you can get access to this information.