Employer Medicare Plan Materials and Forms
How to View and Download Files
To view or download a file, click the desired language link. The PDF file will open in a new window or tab of your browser. From there, you can also download or print the file.
- 2026 Seniority Plus Overview Brochure – English (PDF)
- 2026 Healthy Discounts Brochure – English (PDF)
- 2026 Silver&Fit Flyer – English (PDF)
- 2025 Medicare Step Therapy Part B (PDF)
- 2026 Health Net Medicare Claim Form & Foreign Claim Questionnaire – English (PDF)
- How to Choose a Hospital flyer – English (PDF)
- Tag Lines & Nondiscrimination Notice – Multilingual (PDF)
- Notice of Availability – Multilingual (PDF)
- Employer Group Medicare Drug and Pharmacy Information
- Employer Group Medicare – Prescription Drug Claim Form – English (PDF)
- Employer Group Medicare – Prescription Drug Claim Form – En Español (Spanish) (PDF)
- Express Scripts Mail Order Form – English (PDF)
- Express Scripts Mail Order Form – En Español (Spanish) (PDF)
- Covered Diabetes Testing Supplies – English (PDF)
- List of Drugs (Formulary) and Change Notices
- Drug Coverage Determination (Exception)
- Drug Redetermination (Appeal) Forms
- 2026 Medicare Step Therapy Part B – English (PDF)
- Part D Prior Authorization Criteria
- Part D Step Therapy Criteria Forms
- Appointment of Representative Form – English (PDF)
- Appointment of Representative Form – En Español (Spanish) (PDF)
If you have questions about any of the documents on this page, please contact Member Services. We’re here to help.