Group POS Plans

SBCs

In compliance with new requirements of the Affordable Care Act, Health First Health Plans has made available a Summary of Benefits and Coverage (SBC) for our group plans. View all SBCs here.

Participating Providers

• Physician Search

Authorizations

2021

• 5 Tier Commercial Metal Prior Authorization and 5 Tier Commercial Metal Step Therapy Criteria
• 5 Tier Commercial Prior Authorization and 5 Tier Commercial Step Therapy Criteria
• 3 Tier Commercial Prior Authorization and 3 Tier Commercial Step Therapy Criteria

2020

• 5 Tier Commercial Metal Prior Authorization and 5 Tier Commercial Metal Step Therapy Criteria
• 5 Tier Commercial Prior Authorization and 5 Tier Commercial Step Therapy Criteria
• 3 Tier Commercial Prior Authorization and 3 Tier Commercial Step Therapy Criteria

Drug Lists (Formularies)

2021

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

2020

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

Forms

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

Pediatric dental coverage