POMCO FORMS

CVS Caremark Registration Page - click here

You should be able to view any of these documents by clicking on them.  You can download any of these also, by right - clicking and choosing "save document as".

Medical Claim Form

Dental Claim Form

Flexible Benefits Form

Full Time Student Form

Benefit Booklets

Health Plan Booklet - This is the major summary of our health plan.  Additions & changes are found in the documents below.

Addition 1 - Change of Plan Name

Addition 2 - Act of War/Riots Exclusion

Addition 3 - Eligibility Changes, Cobra, Domestic Partners, Routine Physicals

Addition 4 - Summary of Benefit changes

Addition 5 - Plan Changes

Addition 6 - Change in name of pharmacy manager

Addition 7 - Change in Calendar year and Lifetime maximums

Dental Plan Booklet - This is the summary of our entire Dental Plan.  Additions and changes are found in the documents below.

Addition 1

Addition 2

Dental Maximums - increase in dental lifetime and yearly coverage

 

Over The Counter Drugs - summary of OTC drugs that are covered under flex benefits