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Appeals, Exceptions & Grievances Forms
  • Physician Documentation for Exception
  • Appointment of Representative
  • Your Appeal Rights
  • Appeals & Grievances Instructions
  • Physician Documentation for a Non-Preferred
       Formulary Drug Exception
  • Request for a Medicare Prescription Drug
       Coverage Determination
  • Annual Notice of Change / LIS Charts
    2008 Annual Notice of Change
    2008 Low Income Subsidy (LIS) Chart

    Authorization / Release Form

    Information Release Authorization
    Revocation of Info Release Authorization
    Benefits Guides & Summaries
  • 2008 Introduction to the Summary of Benefits
  • 2008 UPREHS Prime Medicare Plan Benefit
       guide book
  • Company Brochures & Newsletters
    UPREHS Company Brochure
    2007 UPREHS Newsletter
    Preventing Fraud
    Medicare Drug Coverage
    Comparison of Outpatient Prescription Drug Coverage
    Formularies
    Preferred Drug Formulary
    Non-Preferred Drug Formulary

    HIPPA
    HIPAA Privacy Notice
    Pharmacy Forms
  • Prescription Claim Form
  • Prior Authorization for Compound Drugs
       Policies & Procedures
  • Coordination of Benefits Form
  • Physician Prescription Fax Form

  • Policies
    Privacy Policies
    Legal Disclaimers
    Privacy Notice
    Quality Assurance


    Last Updated 05/08/2008
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