Documents & Forms Center

2025 Capital City Bank Retiree Advantage

PDF icon 2025-Capital-City-Bank-Retiree-Advantage.pdf

2025 Capital Selection 15.30.50

PDF icon 2025-Capital-Selection-15.30.50-Copay-Sheet-effective-10012023.pdf

2025 Capital Selection 15.50.100 Schedule of Copayments

PDF icon 2025-Capital-Selection-15.50.100-Schedule-of-Copayments.pdf

2025 FEHB Open Enrollment Presentation

PDF icon FEHB-2025-RI-73-197-10302024.pdf

2025 FEHB SBC

PDF icon FEHB-High_Option15.40.100 1-1-25.pdf

Members

2025 HMO Individual Contract

PDF icon 2024.21.HMO_.IndQHP-COC.pdf

Agents, Employers

2025 Large Group Benefits

PDF icon 2025_LG_Benefits-FINAL.pdf

Medicare 2025

2025 Medicare Star Rating

PDF icon 2025-Medicare-Star-Rating.pdf

Medicare 2025

2025 Over-the-Counter (OTC) Product Catalog

PDF icon CAPF-CAT-OTC-List-2025-EN.pdf

2025 Preferred Advantage Annual Notice of Change

PDF icon H5938-006-HMO-ANOC-2025-R4.pdf

2025 Preferred Advantage Evidence of Coverage

PDF icon H5938-006-HMO-EOC-2025-FINAL2_508.pdf

2025 Premier Plus Selection Schedule of Copayments

PDF icon 2025-Premier-Plus-Selection-Schedule-of-Copayments.pdf

2025 Premier Selection Schedule of Copays 2

PDF icon 2025-Premier-Selection-Schedule-of-Copays-2.pdf

2025 Primary Care Selection Retiree Advantage

PDF icon 2025-Primary-Care-Selection-Retiree-Advantage.pdf

Members

2025 Principal Choice - Medicus

PDF icon PrincipalChoice-15.50.100-Medicus-Bariatric_1-1-25.pdf

Members

2025 Principal Choice - TMH

PDF icon PrincipalChoice-15.50.100-TMH-Bariatric_1-1-25.pdf

2025 Principal Choice Schedule of Copayments

PDF icon 2025-Principal-Choice-Schedule-of-Copayments.pdf

2025 Principal Choice Schedule of Copayments

PDF icon 2025_Principal_Choice_Schedule_of_Copayments.pdf

2025 Quality of Choice 15.30.50 Schedule of Copays

PDF icon 2025-Quality-of-Choice-15.30.50-Schedule-of-Copays.pdf

2025 Quality of Choice 15.50.100 Schedule of Copayments

PDF icon 2025-Quality-of-Choice-15.50.100-Schedule-of-Copayments.pdf

2025 Retiree Advantage Annual Notice of Change

PDF icon H5938-802-EGWP-HMO-ANOC-2025-FINAL.pdf

2025 Retiree Advantage Annual Notice of Change

PDF icon H5938-802-EGWP-HMO-ANOC-2025-FINAL (1).pdf

Medicare, Members

2025 Retiree Advantage Annual Notice of Change

PDF icon H5938-802-EGWP-HMO-ANOC-2025-FINAL.pdf

2025 Retiree Advantage Enrollment Application

PDF icon 2025-Retiree-Advantage-Plan-Enrollment-Application-V-2.pdf