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Dependent Ver Form 2022
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Flex Spending Form
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Vision Claim Form
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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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Language Access
Download our PDF English: We have free interpreter services to answer any questions you may have about our health or drug plan. To get an interpreter, just call us at 1- 800-577-5084 (TTY 711). Someone who speaks English can help you. This is a free service. Pennsylvania Dutch Deitsch Die Bekanntmaching gebt…
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Provider Resources
AultCare values the relationships we have with our network providers. As healthcare continues to evolve, we recognize the many challenges providers face and aim to be a resource for your practices. Our provider portal is full of many resources available to AultCare providers. Providers can use the portal to view…
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Pharmacy Services
If you are in need of immediate medical attention, contact your physician, poison control center or emergency medical professional. Due to the high number of requests we receive, the replies can take up to two business days. The information appearing in this resource is intended to be a general guide to…
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Large Group Census Form AultCare
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Electronic Medical PA Referral Form Guide
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7458 21 EFT Authorization Form
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