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2020 Plan Year Documents

2020 Plan Year Documents for Farm Bureau Select Rx
Summary of Benefits
Annual Notice of Change (ANOC)
Evidence of Coverage
Pharmacy Directory
Comprehensive Formulary
Prior Authorization Criteria
Step Therapy Criteria
Quantity Limits Criteria
2021 LIS Premium Summary
CMS Star Ratings
Enrollment Form
 

2020 Plan Year Documents for Farm Bureau Essential Rx
Summary of Benefits
Annual Notice of Change (ANOC)
Evidence of Coverage
Pharmacy Directory
Comprehensive Formulary
Prior Authorization Criteria
Step Therapy Criteria
Quantity Limits Criteria
2021 LIS Premium Summary
CMS Star Ratings
Enrollment Form
 

Other Forms & Documents
Member Reimbursement Drug Claim Form
Appointment of Representative Form
Coverage Determination Request Form
Request for Redetermination
Request for Reconsideration
SSA Extra Help Information
Personal Medication List

Premium Billing/Payment
Premium Payments FAQ
Bank Withdrawal Form
Credit Card Authorization Form
 

2021 Plan Year Documents

2021 Plan Year Documents for Farm Bureau Select Rx
Summary of Benefits
Annual Notice of Change (ANOC)
Evidence of Coverage
Pharmacy Directory
Comprehensive Formulary
Prior Authorization Criteria
Step Therapy Criteria
Quantity Limits Criteria
2021 LIS Premium Summary
CMS Star Ratings
Enrollment Form
 

2021 Plan Year Documents for Farm Bureau Essential Rx
Summary of Benefits
Annual Notice of Change (ANOC)
Evidence of Coverage
Pharmacy Directory
Comprehensive Formulary
Prior Authorization Criteria
Step Therapy Criteria
Quantity Limits Criteria
2021 LIS Premium Summary
CMS Star Ratings
Enrollment Form
 

Other Forms & Documents
Member Reimbursement Drug Claim Form
Appointment of Representative Form
Coverage Determination Request Form
Request for Redetermination
Request for Reconsideration
SSA Extra Help Information
Personal Medication List

Premium Billing/Payment
Premium Payments FAQ
Bank Withdrawal Form
Credit Card Authorization Form