Forms 2022

California Health Plans must cover the levels of care described in American Society of Addiction Medicine guidelines.

Cigna + Oscar Documents & Forms have moved to a standalone webpage! Please use the link below:

CT Employee Enrollment Form

CT Employer Enrollment Form

C+O Deductible Credit Carryover Guideline

C O Deductible Carryover P P TN GA 2021 vF

CA Disabled Dependent Form

Cigna + Oscar Continuity & Transition of Care Guidelines

Deductible Credit Form

CA Employee Waiver Form

C+O California Underwriting Guidelines

CA Creditable Coverage Form

C+O HIPAA Authorization Form

C+O Autorización para: Divulgación de información médica protegida

C+O Notice of Privacy Practices 

MO Employer Enrollment Form

ESI Prescription Reimbursement Direct Claims Form (english)

Express Scripts Home Delivery Form - Web Version - English

C+O Utilization Management Notice

C+O Medical Authorization Request Form

C+O Member Claim Form 

2022 C+O CA NQTL Disclosure Form 

C+O OTC Claims Reimbursement Form

C+O Transparency in Coverage

Oscar Insurance Corporation Group Policy

Rider for Coverage for Medically Necessary Abortions

Rider for Coverage for Contraceptive Drugs and Devices and Family Planning Services

Rider For Age 29 Coverage Small Group

Rider To Extend Skilled Nursing Facility Small Group

Rider For Domestic Partner Coverage Small Group

Oscar 4T CA STND Member Doc (December 2022) as of 11102022

Oscar 4T CA FERT Member Doc (December 2022) as of 11102022

OSCAR-OSCAR CY20 CORE (DEC 20 3 CRIT)-2020-PACriteria updated

Mail Order Form

Prescription Reimbursement Form

2022 Oscar CA IND Bronze 60 Select LCS CY V

Member Rights and Responsibilities

Disabled Adult Dependent Request Form

Transparency in Coverage CA

Address Verification Form

Authorized Representative Form

Off- Exchange Paper Application OH

Hipaa Authorization Form

Autorización para: Divulgación de información médica protegida

Outline Of Coverage IA

Outline Of Coverage PA

Outline Of Coverage OK

Off-Exchange Paper Application CO

Outline Of Coverage AR

Individual On Exchange Age 29 Rider

Individual Off Exchange Age 29 Rider

Outline Of Coverage KS

CA Utilization Management Notice  

IL External Appeal Form

Notice of Privacy Practices

Oscar Continuity and Transition of Care Guidelines

Member Claim Form

CA 22- Grievance & Appeal Form

Covered California Member Contact Guidelines

An Explanation of Oscar's Individual & Family Commissions Schedule CA

On Off Exchange Member Notification Oscar Population Health Programs 2022 

Member STD STI Kit Form

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Forms and Notices