Forms and information
Call us at 844-427-8501 if you need help with these forms.
- Appeal filing form
- Authorization for release of protected health information
- Continuity of care request form
- Late self-payment request/appeal form
- Life insurance beneficiary form
- Mail order pharmacy form
- Prescription reimbursement claim form
- 1095-B tax form
Get to know your benefits. That will help you know what is available to you. To find out about your benefits call us at 844-427-8501.
- Are you using your new Alaska Plan ID cards?
- Let us help you get the most out of your health benefits!
Download a copy of your Participant Guide.
Summary Annual Report (SAR)
Summary of Benefits and Coverage (SBC)
Download a copy of your Summary of Benefits and Coverage (SBC). It gives you a quick outline of some of your benefits and costs.
Benefits at a Glance
View your Benefits at a Glance:
Summary Plan Description (SPD)
View your Summary Plan Description (SPD). It explains all of your benefits.
Summary of Material Modifications (SMM)
After each SPD is published, certain changes may have been made to your benefits. These changes are reflected in a Summary of Material Modifications (SMM).
Your Rights and Protections Against Surprise Medical Bills
When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory (outpatient) surgical center, you are protected from “surprise billing” or “balance billing.” More information