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Forms

Optum Rx Form Downloads

  • Claim form – Commercial (pdf)

High Deductible 2026 Benefits At a Glance

  • High Deductible HMO 2026 Benefits At A Glance (pdf)
  • High Deductible PPO 2026 Benefits At A Glance (pdf)

Standard Deductible 2026 Benefits At A Glance

  • Standard HMO 2026 Benefits At A Glance (pdf)
  • Standard PPO 2026 Benefits At A Glance (pdf)

Pharmacy Benefit Summary 2026

  • State of Florida 2026 Pharmacy Benefit Summary - English (pdf)
  • State of Florida 2026 Pharmacy Benefit Summary - Spanish (pdf)

Maintenance Drug List

  • State of Florida Maintenance Drug List July 1 2025 (pdf)
  • State of Florida Maintenance Drug List January 2026 (pdf)

State of Florida Preferred Drug List

  • State of Florida Preferred Drug List July 2025 (pdf)
  • State of Florida Preferred Drug List July 2025 (pdf)
  • State of Florida Preferred Drug List January 2026 (pdf)
  • State of Florida Preferred Drug List- January 2026- Spanish (pdf)
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