All of the forms related to the CT State Employee Health Plan have been consolidated in one location under the CareCompass portal.
Some of the more commonly used healthcare forms are linked below, a complete list of Healthcare Forms can be found here:
- Emergency Room Co-payment Waiver Request Form: Use this form if you seek a waiver for the $250 co-pay for a visit to the ER
- Lab and Radiology Coinsurance Waiver Form: Use this form if you seek a waiver for the coinsurance charges in connection with lab or radiology services at a non prefered site of service provider.
- Coverage Exception Request Form For Prescription Drugs
- CVS Caremark Mail Service Order Form
- Physician's Notification Form (Attestations/Exemptions) Use this form if your doctor determines that an exemption from a HEP requirement is appropriate, or as verification that a HEP requirement was completed.