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• Dental Claim Form

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• HIPAA Member Request To Restrict Uses and Disclosures Of PHI Form AultCare

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• Breast Cancer Preventive Medications Enrollment Form AultCare

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• Find a Provider

  It’s easy to find a provider by first choosing the type of card you have. For example, AultCare Provider Network member cards may look similar, but they have differences that you can match from the images shown.

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• 4228 10 Timken Cardiovascular Flyer 7263 21

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• Generic Incentive Program

  This program assists members with transitioning to a generic equivalent for certain medications when clinically appropriate. An incentive may reduce member cost share. This cost-share adjustment is based on brand name manufacturer assistance programs. Please call AultCare Customer Service at 330-363-6360 or 1-800-344-8858 (TTY 711) for any questions regarding this…

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• HIPAA Confidential Communication Request Form AultCare

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• Health Care Coverage Forms For Annuitants FEHB AultCare

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• MarketPlace Step Therapy Request Enrollment Form

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• Facility Information Form 1021 fillable

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