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Documents and Forms

Looking for information about you Added Choice plan? View, download, or print commonly used forms, reference guides, and other documents here.

Quick Documents

Drug Formularies:
Mid-Atlantic States Formulary

Specialty Drugs List

Pharmacy Claim Form

Precertification Lists:
VA Added Choice Precertification List

MD Added Choice Precertification List

D.C. Added Choice Precertification List

Member Resources:
Medical Claim Form

Small Group Signature Added Choice Flyer

Mid-Large Group Signature Added Choice Flyer

Small Group Select Added Choice Flyer

Mid-Large Group Select Added Choice Flyer

Mid-Large Group Signature Added Choice Plan Reference Guide

Small Group Signature Added Choice Plan Reference Guide

Mid-Large Group Select Added Choice Plan Reference Guide

Small Group Select Added Choice Plan Reference Guide

Small Group Signature Deductible Added Choice Plan Reference Guide

Small Group Select Deductible Added Choice Plan Reference Guide

Added Choice Information for Physicians

Precertification Request Form

Your Rights and Protection Against Surprise Medical Bills – Maryland

Your Rights and Protection Against Surprise Medical Bills – District of Columbia

Your Rights and Protection Against Surprise Medical Bills – Virginia