Benefit Plan Information

Annual Notice of Change

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Annual Notice of Change
2011 to 2012

Ascent
Alpine
Sound + Rx

Charter + Rx

Apex + Rx

Summit + Rx to Apex + Rx

 

 Evidence of Coverage

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2012 Evidence of Coverage Documents

Ascent

Alpine - (Alpine Errata Notification)

Sound + Rx*

Pinnacle + Rx** - (Pinnacle Errata Notification)

Charter + Rx

Apex + Rx - (Apex Errata Notification)

 * Sound + Rx is available only in King, Lewis, Pierce, Snohomish and Thurston counties in 2012.
 

** Pinnacle + Rx is available only in Chelan, Douglas, Grant and Whatcom counties in 2012.

Formulary

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2012 Formulary Documents

2012 Comprehensive Formulary

 

2012 Step Therapy Requirements

 

2012 Prior Authorizations

 

 

Summary of Benefits

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 2012 Summary of Benefit Documents

2012 Summary of Benefits - Ascent and Alpine

 

2012 Summary of Benefits - Sound, Charter and Apex

 

2012 Summary of Benefits - Pinnacle, Charter and Apex

 

Grievance and Appeals Process

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Page Last Updated: November 7, 2011