Forms

Enrollment Form

Fitness Claim Form - for Eastern Missouri & Arkansas

Fitness Claim Form - for Southwest Missouri

H1N1 Flu Shot Reimbursement Form

Seasonal Flu Shot Reimbursement Form

Part D Coverage Determination
     See document for submission instructions or to make
     determinations (exceptions) requests by phone call:
     Southwest Missouri/Arkansas area: 1-855-840-0400
     St. Louis Area: 1-800-280-1602

CMS Appointment of Representation form

Request for Medicare Prescription Drug Determination Request Form

Publications

Low Income Subsidy Eligibility

Help with Medicare Prescription Drug Plan Costs

5 Ways to Lower Your Costs During the Coverage Gap

Hospital Comparisons

Live Well

Fitness Reimbursement
Health Info
Interactive Tools
Symptom Checker
Drug Interaction Checker
Preventive Health Guidelines