Important documents

On this page you'll find samples of the following important medical plan documents. Please use the information here as a general reference. 

  • Sample Certificates of Coverage
  • Prior Authorization Guides

Employer Prior Authorization Guides

These sample documents are for employer groups with 51 or more employees with plan effective date on or after January 1, 2022. Please review the prior-authorization document that applies to your state of residence.

The employer guides shown here provide directions and highlights prior authorization (PA) requirements which may apply to either network or out-of-network services, or both.