• Wellness Rewards Reimbursement Form
  
  
• Member’s Designation of a Personal Representative
  
  
• Health Care Proxy Form

Prescription Drug Plan Forms

• CVS/Caremark Mail Order Enrollment Form

• CVS/Caremark Prescription Reimbursement Claim Form

More Forms (Enrollment, Termination, etc.)

• Continuation of Coverage Election Form
  (eff. 7/1/2023)
  
  
• Main Forms & Documents Page

• Enhanced Blue Cross PPO Plan Summary of Benefits & Coverage (SBC)
  English | Spanish | Portuguese
  
  
• Basic Blue Cross PPO Plan Summary of Benefits & Coverage (SBC)
  English | Spanish | Portuguese
  
  
• High Deductible Health Plan Summary of Benefits & Coverage (SBC)
  English | Spanish | Portuguese
  
  
• Enhanced Blue Cross PPO Plan Medicare Primary Payer Participant - Summary of Benefits & Coverage (SBC)
  
  
• Basic Blue Cross PPO Plan Medicare Primary Payer Participant – Summary of Benefits & Coverage (SBC)
  
  
• Section 125 Cafeteria Plan Summary
  
  
• FAQs for Employees Receiving 1095-C Forms
  
  
• Disclosure: RCAB Wellness Program Reasonable Accommodation/Reasonable Alternative Availability

• Prescription Benefit Summary – Enhanced Plan
  
  
• Prescription Benefit Summary – Basic Plan
  
  
• CVS/Caremark Mail Service Pharmacy
  
  
• Getting Started with CVS Caremark Mail Service
  
  
• RCAB CVS Caremark Maintenance Choice FAQs

• No Surprises Act Notice

• CHIP Notice

• HIPAA Privacy Notice

• Medicare Part D Notice

• ACA Marketplace Exchange Notice
  

• Additional Health Plan Notices