MHBP Official Plan Brochures
Below is a listing of plan forms, brochures and documents to help you manage and understand your benefits.
| Title | Description | Download |
|---|---|---|
| Plan Brochure | 2023 MHBP Plans Overview Brochure | |
| Plan Brochure | OPM Brochure – Standard Option and Value Plan 2023 | |
| Plan Brochure | OPM Brochure – Consumer Option Plan 2023 | |
| SBC – 2023 Standard Option | Summary of Benefits and Coverage, 2023 Standard Option | |
| SBC – 2023 Value Plan | Summary of Benefits and Coverage, 2023 Value Plan | |
| SBC – 2023 Consumer Option | Summary of Benefits and Coverage, 2023 Consumer Option | |
| Plan Brochure | 2023 Medicare Plan Brochure | |
| Plan Brochure | 2023 Medicare – 2023 Schedule of Cost Sharing – Medicare Advantage | |
| Plan Brochure | 2023 Medicare – 2023 Evidence of Coverage – Medicare Advantage | |
| Plan Brochure | 2023 Medicare Summary of Benefits Guide | |
| Plan Brochure | 2022 MHBP Plans Overview Brochure | |
| Plan Brochure | OPM Brochure – Standard Option and Value Plan 2022 | |
| Plan Brochure | OPM Brochure – Consumer Option Plan 2022 | |
| SBC – 2022 Standard Option | Summary of Benefits and Coverage, 2022 Standard Option | |
| SBC – 2022 Value Plan | Summary of Benefits and Coverage, 2022 Value Plan | |
| SBC – 2022 Consumer Option | Summary of Benefits and Coverage, 2022 Consumer Option | |
| 2022 Medicare | Summary of Benefits Guide – 2022 Aetna Medicare Advantage for MHBP Standard Option members | |
| 2022 Medicare | 2022 MHBP Medicare Brochure | |
| 2022 Medicare | Medicare Rewards Program – Medicare Advantage | |
| Plan Brochure | OPM Brochure – Standard Option and Value Plan 2021 | |
| Plan Brochure | OPM Brochure – Consumer Option Plan 2021 | |
| Member Guide | Know Where to Go | |
| Member Guide | Making the Most out of MHBP | |
| Prescription Drug Form | Contraceptive Management Exception Form
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| Prescription Drug List | Prescription Drug Guide/Formulary | |
| Prescription Drug List | Advanced Control Specialty Formulary | |
| Prescription Drug List | Formulary Exclusion Drug List | |
| Prescription Drug List | Prior Authorization Drug List | |
| Member Form | Prescription Drug Brand Exception Form | |
| Claim Form | Medical Claim Form | |
| Claim Form | Prescription Reimbursement Claim Form | |
| Claim Form | International Medical claim form | |
| Claim Form | Dental Claim Form (MHBP Dental Plan only) | |
| Claim Form | Wellness Incentive Claim Form | |
| Claim Form | Prescription, Mail Order Caremark Mail Order Service Claim Form | |
| Member Form | Coordination of Benefits Form | |
| Member Form | Consumer Option HRA Reimbursement Request | |
| Member Form | Consumer Option HSA Transfer Form | |
| Member Form | Consumer Option HSA Excess Contribution Form | |
| Member Form | Health Savings Account (HSA) Custodial Agreement | |
| Member Form | Health Savings Account (HSA) Fee Schedule | |
| Member Form | Utah Network Selection Form | |
| Privacy Notices | Privacy notice | |
| Privacy Notices | Privacy Notice – Spanish | |
| Member Form | Authorization for Release of Protected Health Information (PHI) |
Have Questions? Call 1-800-410-7778
24 hours a day, 7 days a week, except major holidays