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Forms & Downloads


Comprehensive list of Forms and Documents

Alphabetical list of PEIA forms and documents

Documents for Benefit Coordinators 


Documents for Health Care Providers


Enrollment Forms


Fee Schedules & Manuals


Financial Reports



Policies & Letters

Prescription Drug Benefits


Preferred Provider Benefit (PPB) Plan
Medicare Advantage Plan (Humana)
Special Medicare Plan (PEIA)

Requests for Proposals, Quotations and Information

Shopper’s Guides

Shopper’s Guides (Active Members)
Medicare Shopper’s Guides

Summary Plan Descriptions


Wellness Tools