Documents & Forms Center

Members

FEHB Member Handbook - Effective 1-1-2022

PDF icon FEHB Member Handbook - Effective 1-1-2022.pdf

Members

Final Rate Determination

PDF icon Final Rate Determination for Website_20231103.pdf

Financial Statement 2016

PDF icon Financial Statement 2016.pdf

Financial Statement December 31 2019 and 2018

PDF icon Financial Statement December 31 2019 and 2018.pdf

Financial Statement December 31 2089 and 2017

PDF icon Financial Statement December 31 2018 and 2017.pdf

Fraud Waste and Abuse Awareness and Reporting Policy

PDF icon Fraud Waste and Abuse Awareness and Reporting Policy.pdf

Fraud Waste and Abuse Awareness and Reporting Policy 5-23-17

PDF icon Fraud Waste and Abuse Awareness and Reporting Policy 5-23-17.pdf

Members

General Pregnancy Information

PDF icon General Pregnancy Information.pdf

Agents, Employers, Members

General Reimbursement Request

PDF icon General Reimbursement Request.pdf

Agents, Employers, Members

Getting Care In A Disaster Area

PDF icon Getting Care In A Disaster Area.pdf

Agents, Employers, Members, Providers

Glossary of Health Coverage and Medical Terms

PDF icon Glossary of Health Coverage and Medical Terms.pdf

Grievances and Appeals_Commercial Members

PDF icon Grievances and Appeals Commercial Members.pdf

Group Biographical Information

PDF icon Group Biographical Form Rev 2019 - Fillable.pdf

OEP

H5938 DP1478 C2019 Agent Flyer

PDF icon H5938_DP1478_C2019-Agent-Flyer-for-Website.pdf

Agents, Employers, Medicare, Members, Providers

Health and Fitness Reimbursement Form

PDF icon Fitness Reimbursement Form 040820 FILLABLE.pdf

Members

Healthline Newsletter Fall 2023

PDF icon 23-CHP-029 Healthline Newsletter Fall 2023-V3_3.pdf

Members

Healthline Newsletter February 2023

PDF icon 23-CHP-002-Healthline-Newsletter-Update-DIGITAL-V2-2.pdf

Members

Healthline Newsletter February 2023

PDF icon 23-CHP-002-Healthline-Newsletter-Update-DIGITAL-V2-2.pdf

Members

Healthline Newsletter February 2023

PDF icon 23-CHP-002-Healthline-Newsletter-Update-DIGITAL-V2-2.pdf

Medicare, Providers

Implantable Hearing Devices MCR

PDF icon Implantable-Hearing-Devices-MCR.pdf

Individual - Gold 3000

PDF icon Gold3000.pdf

Individual - Gold 3000 AIAN Limited Cost

PDF icon Gold3000AIANLimitedCost.pdf

Individual - Gold 3001 AIAN Zero Cost Sharing

PDF icon Gold3001AIANZeroCostSharing.pdf

Individual - Silver 2000

PDF icon Silver2000.pdf