These plans are available to Brevard businesses for their employees. They feature low copayments at network providers, and also the option of receiving care outside of our network.

Benefits

Prescription drug information

• Participating pharmacies
• 5-tier drug list (formulary)
• 3-tier drug list (formulary)
• Special savings on select prescriptions
• Prescription reimbursement form
• Prescription mail order form
• Order mail order prescriptions online
• Pharmacy authorization/exception request form - must be completed and submitted by your physician

Provider information

• Provider directory (search for physicians)
• Provider directory (printable format)
• Ancillary services (labs, hospitals, etc.)
• Participating pharmacies

Authorizations

• Medical services that require authorization
• Medical authorization request form - must be completed and submitted by your physician
• Pharmacy authorization/exception request form

General information

• Member handbook
• Group exclusions and limitations
•  Pro-Health benefit
• Member rights and responsibilities
• Notice of privacy practices
• Member newsletter
• Health education and programs
• Agency for Health Care Adminstration

Forms

• Prescription mail order form
• Prescription reimbursement form
• General reimbursement form
• Appoint a representative - authorize someone to act on your behalf
• Pharmacy authorization/exception request form - must be completed and submitted by your physician
• Medical authorization request form - must be completed and submitted by your physician

This information provides a general overview of our commercial POS plans with answers to important questions. For detailed information, please refer to the Member Handbook or Certificate of Coverage, or contact Customer Service.