Login
About our company
Overview
Our company
About our company
Health plan 101
Quality
News
Media contacts
Contact us
Resources
Business transparency
Drug exception time frame
Population health
Premium refunds
Grace period and claims
Retroactive denials
Member claims
Web
Website privacy policy
Website terms of use
Glossary of terms
Provider term glossary
Legal
First-tier, downstream and related entities
Legal resources
Member rights & responsibilities
Privacy policy
Terms and conditions
Fraud & health care
Find a doctor
Overview
Online directories
Find a doctor
Find a location
Find a pharmacy
Find a Medicare pharmacy
Resources
24-hour nurse advice line
E-Visit
Out-of-area coverage
Continuity of care
Contact us
PDF directories
Illinois Individual (HMO) Marketplace/Commercial
Medicare Advantage
Individuals & Families
Overview
Shop plans
Individual & family home
Individual & family kit request
Special enrollment
New to WellFirst Health
News
Resources
Member center
Cost estimator
Pay your premium
Prior authorization
Traveling out-of-area
Business transparency
Coronavirus (COVID-19)
Wellness
Wellness home
Preventive care
Care management
Advance care planning
Pregnancy & baby
Living Healthy home
Population health
Pharmacy benefits
Pharmacy benefits
Drug formulary
Save on prescription drugs
Flu vaccinations
Find a pharmacy
Medicare
Overview
Shop plans
Shop Medicare Advantage home
Medicare Advantage plan details
Information request form
Meet with an agent
Service area
Special enrollment period
Resources
Medicare member center
2023 additional benefits
Diabetes benefits
Care management
Preventive care
Medicare Extra Help
About our plans
Medicare home
New to Medicare
Seminars
Benefit webinars
Golden Notables Newsletter
Veterans Medicare plans
HMO/POS benefits Q&A
Pharmacy benefits
Part D pharmacy benefits home
Medicare Advantage formulary
Medical management
Pharmacy locations
Out-of-network pharmacies
Vaccines
Providers
Agents
Menu
Home
Document Library
Document Library
Search for:
By Audience:
Agent
Employer
Member
Provider
All
By Category:
Applications
Behavioral Health
Brochures
Drug formulary
Drug Policies
Forms
Genetic testing
Genetic testing
Manuals
Medical Policies
Misc Documents
Miscellaneous documents
Pharmacy Resources
Plan Documents
Provider directory
Q&A
SSM Prior Authorization
All
241 results found.
Member paid claim reimbursement form
pdf
|
Please visit Navitus for the submission form and directions to
submit an over the counter Covid 19 at home test claim for reimbursement
.
Member Exception to coverage request
pdf
|
Medicare pre-enrollment checklist
pdf
|
Advance care planning checklist
pdf
|
Advance care planning FAQs
pdf
|
Walgreens Mail Order registration form
pdf
|
Member exception to coverage form
pdf
|
Instrucciones para visualizar WebMD ONE en Español
pdf
|
2022 Medicare Education Guide
pdf
|
1
2
3
4
5