member resources
Employee Health Plan Benefits
California Medical Benefits
- Side-by-Side Benefit Comparison
- Summary of Benefits and Coverage (SBC)
- Summary Plan Description (SPD)
- Summary of Benefits and Coverage (SBC) – AHRO and AHMC
- Summary Plan Description (SPD) - AHRO and AHMC
- Balance Bill Resource Guide
Medical Benefits for Members Outside of California
- Side-by-Side Benefit Comparison
- Summary of Benefits and Coverage (SBC)
- Summary Plan Description (SPD)
- Summary of Benefits and Coverage (SBC) - AHCG
- Summary Plan Description (SPD) - AHCG
Legal and Privacy notices
Pharmacy benefits
- Pharmacy Benefit
- Zero Dollar Copay Medication List
- In-house and Community Partner Pharmacy List
- OptumRx Formulary
- OptumRx Claim Form
- OptumRx website and app brochure
- Preventive Care Medications
- Free Glucose Monitor
Forms
- Prior Authorization/Unavailable Services Request Form
- Prior Authorization Matrix
- 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
2022 Documents and Forms
Medical benefits
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
2023 Documents and Forms
Medical benefits
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
- In-house and 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
- Prior Authorization Matrix
- 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