November 1 2017 Updated Drug List Form

/November 1 2017 Updated Drug List Form
November 1 2017 Updated Drug List Form 2017-11-26T01:17:55+00:00

Plan(s) applies to the Extended Health Care Plan

Use this form to request coverage of a drug that is NOT automatically covered under your drug plan. Please provide the requested information to ensure a timely assessment of your claim.

Please click on the button below for further information and form to print a copy for your self to use.

Request for a Drug Exception Form