Forms
Below are some useful resources and forms for each of the plan options.
2026 Plan Documents
- Benefits Comparison Chart (PDF)
- 2026 Plan Information Booklet (PDF)
English | Spanish - 2026 BlueChoice Brochure (PDF)
- Proof of Coverage and Tax Identification Number (TIN) Collection FAQs (PDF)
- Medical Policy
- Contraception Coverage (PDF)
- Disputed Claims Process (PDF)
- 2026 Postal Service Health Benefits Program and Medicare Prescription Drug Plan (PDF)
- PSHB and Medicare At A Glance (PDF)
2025 Plan Documents
2026 Medicare Rx (PDP) Documents
- PSHBP Medicare Rx 2 Summary of Benefits (PDF)
- PSHBP Medicare Rx 4 Summary of Benefits (PDF)
- 2026 Medicare Rx Evidence of Coverage (PDF)
- 2026 Annual Notice of Change (PDF)
English | Spanish - Designation of Personal Representative Form (PDF)
(Use this form to designate someone who will be authorized to make health care coverage decisions on your behalf.)
2025 Medicare Rx (PDP) Documents
Plan Forms
- Coordination of Benefits (PDF)
- HSA/HRA Selection Form (PDF)
- Medical Claim Form (PDF)
- Prescription Mail Order Form (PDF)
- Prescription Reimbursement Claim Form (PDF)
- Social Security Number Submission Form (PDF)
- Vision Claim Form - Davis (PDF)
- International Claim Form (PDF)
(for members receiving care outside of the U.S.)
