Commercial Group Members

Select your plan for FAQs, benefits, provider directories, drug lists, member rights and responsibilities, and more.

General Information

• Fitness Benefits
• Member Guidebook
• Covered preventive services
• Summaries of Benefits and Coverage (SBCs)
• Transparency in Coverage
• Fight healthcare fraud

Authorizations—for AdventHealth Employee Health Plan members

• Authorization List—Non-emergency medical procedures that require prior authorization
• Medical Drug Authorization List - Reference list of codes for injectable and infusible medications

Authorizations—for Rosen Hotel and Resort Employee Plan members

• Authorization List—Non-emergency medical procedures that require prior authorization
• Medical Drug Authorization List - Reference list of codes for injectable and infusible medications

Authorizations—for all other members

• Authorization List—Non-emergency medical procedures that require prior authorization
• Medical Drug Authorization List - Reference list of codes for injectable and infusible medications
• 2020 5 Tier Commercial Metal Prior Authorization and Step Therapy Criteria
• 2020 5 Tier Commercial Prior Authorization and Step Therapy Criteria
• 2020 3 Tier Commercial Prior Authorization and Step Therapy Criteria

Participating Providers:

• Provider Directory and Search

Forms

• Prescription mail order form
• Prescription drug reimbursement form
• Medical reimbursement form
• Authorization to disclose your Protected Health Information (PHI) form
• Request for Prescription Drug Coverage Decision - must be completed and submitted by your physician
• Medical authorization request form - must be completed and submitted by your physician
• Appointment of Representation

2020 Pharmacy Information (list of covered drugs)

• 5 Tier Commercial Metal:
  Annual Notice of Change
  Online Search | PDF>
  Monthly Notice of Change
• 5 Tier Commercial:
  Annual Notice of Change
  Online Search | PDF
  Monthly Notice of Change
• 3 Tier Commercial:
  Annual Notice of Change
  Online Search | PDF
  Monthly Notice of Change

For AdventHealth Employee Health Plan pharmacy benefits, contact RxPlus at 866.943.4535.

For Rosen Employee pharmacy benefits, contact EHIM at 800.311.3446.

For detailed information about your covered benefits (copays, deductibles, maximums, etc.), please log in.

For information about Agency for Healthcare Administration (AHCA) click here