Forms and Documents

• HealthShare Program Handbook (PDF) -  Contains the information you need to know about the HealthShare™ program.
• Covered Services, Prior Authorization Requirements, Exclusions and Non-Covered Services (PDF) - Lists covered services and those services that are excluded or not covered. It also indicates which services require prior authorization.
• Drug Formulary (PDF) - Contains a list of covered drugs.
• Employer Application (PDF) - Complete this form if you are an employer interested in enrolling in HealthShare™.
• Employee Health Coverage Survey (PDF) - Use this form for potential enrollment in HealthShare to determine program eligibility.
• Employee Census (Excel) - Complete this form, along with the Employer Application, to determine which employees may be eligible for HealthShare.
• Participating Providers (PDF) - Contains a list clinics, hospitals and other health care providers that participate in HealthShare™.