Adventist Health Employee Health Plan Benefits
View documents and forms from a previous plan year at the links below
Medical benefits
2022 Benefits at-a-Glance
California Medical Benefits
- Side by side benefit comparison
- Summary of Benefits and Coverage (SBC)
- Summary of Benefits and Coverage (SBC) – AHRO and AHMC associates
- Summary Plan Description (SPD)
- Summary Plan Description (SPD) - AHRO and AHMC associates
Medical Benefits for Members Outside of California
- Side by side benefit comparison
- Summary of Benefits and Coverage (SBC)
- Summary Plan Description (SPD)
Legal and Privacy notices
Global Emergency Services
Pharmacy benefits
- Pharmacy Benefit
- Zero Dollar Copay Medication List
- Community Partner Pharmacy List
- OptumRx Formulary
- OptumRx Claim Form
- How to create an OptumRx account
- Preventive Care Medications
- Free glucose monitor
Forms
- Prior Authorization/Unavailable Services Request form
- Medical Claim form
- OptumRx Claim Form
- Coordination of Benefits/Other Insurance form
- General Authorization Designation of Personal Representation and Email Consent form
Flexible Spending Account
For claims and additional information:
- Visit EBCFlex.com
- Call 800-346-2126
Dental
For claims and additional information:
- Visit DeltaDentalins.com/AH
- Call 888-335-8227
Vision
For claims and additional information:
- Visit Adventist.VSPForMe.com
- Call 800-877-7195