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Member Forms and Documents

These documents are in Adobe PDF format. If you have problems viewing these documents, you may need to download and install the free Acrobat reader from Adobe. You can download this program here.


  View Document   Catalyst Rx Pharmacy Welcome Letter 15-Jun-2009 0.02M  
  View Document   Coordination of Benefits Questionnaire 07-Jul-2009 0.01M  
  View Document   HIPAA Authorized Representative Form 15-Jun-2009 0.02M  
  View Document   HMA Behavioral Health Treatment Plan 22-Jul-2010 0.38M  
  View Document   HSTA Prior Authorization List 15-Jun-2009 0.07M  
  View Document   HSTA VEBA Prescription Drug Benefit Summary and PPL 15-Jun-2009 0.31M  
  View Document   HSTA VEBA Transition of Care Form 07-Jul-2009 0.12M  
  View Document   ID Card Letter 15-Jun-2009 0.08M  
  View Document   ID Card Sample 15-Jun-2009 0.03M  
  View Document   LETTER-Provider Directory-Dear Doctor 15-Jun-2009 0.03M  
  View Document   Prior Authorization Form 19-Mar-2010 0.05M  
  View Document   Provider Directory 30-Aug-2010 0.55M  
  View Document   Provider Nomination Form 07-Jul-2009 0.09M  
  View Document   Sample EOB with explanations 31-Jul-2009 0.13M  
  View Document   Summary of Benefits 15-Jun-2009 0.07M  
  View Document   The AKAMAI Way poster 15-Jun-2009 0.21M  


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