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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




Plan Policies & Letters


Prescription Drug Benefits

Preferred Provider Benefit (PPB) Plan
Special Medicare Plan (PEIA)
Prescription Drug Li​sts

Privacy, Security and PHI Policies

PEIA Notice of Privacy Practices

Requests for Proposals, Quotations and Information

Shopper’s Guides

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

Summary Plan Descriptions


Wellness Tools