Electronic Materials Opt-Out Form

You can choose to receive your annual plan materials electronically. Opting-out will notify us to send your documents in paper-format to you. Please fill out the following form to notify us of your opt-out request:

Member ID

First Name

Last Name

Birth Date

Phone Number

Email Address

Opt out of the following electronic materials:

Evidence of Coverage (Your member handbook)

Formulary (The list of covered drugs)

Pharmacy Directory (The list of in-network pharmacies)

Provider Directory (The list of in-network providers)

If you have any questions or need help opting-out, please contact Customer Service.

Electronic Materials Opt-Out Form

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Electronic Materials Opt-Out Form