Documents and Resources
Plan Related Documents
Provider Directory
Explanation of Benefits (EOB)
WVU Medicine Evidence of Coverage (EOC)
WVU Medicine Annual Notice of Change (ANOC)
Marshall Health Summary of Benefits
Marshall Health Evidence of Coverage (EOC)
Marshall Annual Notice of Change (ANOC)
Forms and Policies
Accessing Care During a Disaster
Appointment of Representative (AOR) Form
Diabetes Prevention Program (MDPP)
Flex Card Refund Form
Fraud, Waste and Abuse Reporting
HIPAA Release Form
LIS Premium Summary Chart
Medical Management Policies & Transparency Tool
Medicare Coverage Requests, Appeals, and Grievances
Member Complaint and Appeal Form
Member Medical Claim Form
Non-Discrimination Policy
Notice of Privacy Practices
Transition of Care Form (New Members)
Report a Compliance Concern
Terms and Conditions
Prescription Drug and Pharmacy Information
Covered Diabetes Testing Supplies
Prescription Drug Transition Policy
Medication Therapy Management (MTM)
Personal Medication Worksheet
Medication Action Plan
Preferred Pharmacy Network
Medicare Prescription Payment Plan Information
Member Part D Claim Form
Navitus Member Portal
More Great Benefits
Thank you for choosing Peak! Please see the contact information below for the exciting supplemental benefits you now have access to as a Peak member. Please reference your benefit summary for details regarding these benefits.
Benefit
Member Service Phone Number
Web Address