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Documents and Forms for EMHP Members

File
03-2022 Updated Employee Mask Mandate
02-2022 Updated RTW protocol
01-2022 COVID-19 Leave Requests and Updated Return-to-Work Protocols for Essential Vaccinated Employees
49-2021 Weekly Rapid COVID-19 Testing
48-2021 Employee Mask Mandate
47-2021 Pre-Tax Flexible Benefits Program
45-2021 EMHP Prescription Benefits
45-2021 - FAQs ESI - 2021
43-2021 Attachment - Premium Assistance Under Medicaid 2021
43-2021 Premium Assistance under Medicaid and CHIP
42-2021 Mental Health Parity and Addiction Equity Act of 2008
41-2021 Enrollment in Medicare Parts A (Hospital) and B (Medical) 2022
40-2021 EMHP Annual Notice of Women's Health and Cancer Rights Act of 1998
39-2021 Well-being Coach
38-2021 Annual Open Enrollment for 2022
37-2021 Surprise Billing Notice
36-2021 EMHP Extension of Telephonic Medical Visits
35-2021 Changes to Your EMHP Prescription Benefits & The Prescription Benefits Manager
34-2021 Launch of the New EMHP Website
33-2021 Infusion Site of Care Change Clarification
30-2021 EMHP Mental Health or Sustance Use Disorder Benefits
25-2021 Infusion Site of Care Change
24-2021 - Reminder - EMHP Tele-Medicine Enrollment Giveaway
24-2021 - Access Plus - Tele-Medicine Enrollment Giveway
23-2021 - 24-7 EMHP NurseLine and Sydney App
19-2021 EMHP Telephonic Medical Visits
09-2021 EMHP Paperless Communications
09-2021 Paperless Communications - Notice of Disclosure Form
35-2020 - In Network Providers Utililzing Out Of Network Labs
34-2020 - Increases in In-Network Specialist Copays and Out-of-Netweork Deductible for Medical-Surgical Benefits
EMHP - Specialty Prior Authorization List - 9-1-21
Open Enrollment for 2021
Well-being Coach
Womens Health and Cancer Rights - Annual Notice
Premium Assistance under Medicaid-CHIP
Mental Health Parity and Addiction Equity Act of 2008 (2)
Medicare Enrollment - Parts A (Hospital) and B (Medical)
Out-of-Network Annual Physical Changes - eff 8-1-2020
Eligibility Audit for Coverage and Dependents
COVID-19 EMHP COVERAGE CHANGES 4-24-2020
Tele-Medicine - Re-Registration Required
Tele-Medicine - Access Discount Healthcare - Coronavirus
Change to Acupuncture & Occupational Therapy Benefits
Chiropractic Benefits Change Effective 12-1-2019
Tele-Medicine Provider
Appeals Process (EMHP) - 8-1-2019
Chiropractic Benefits eff 6-1-2019
Changes to your Health Benefits - Issued 5-17-19
Lab Benefit Coverage
Wellmanaged Hyperinflationary Program - eff 9-1-18
Notice of Privacy Practices

File
EMHP - 2020 Clinical Focus Formulary List
EMHP - Clinical Focus Formulary -12-4-20
EMHP - Personalized Medicine List - 10-1-2017
EMHP - Personalized Medicine List - 1-1-2017
EMHP - Personalized Medicine List - 5-1-2017
EMHP - Specialty Drug List 2021 Alpha -12-21-20
EMHP 2014 Basic Plus Formulary List - 5-1-14
EMHP 2016 Preferred Universal Formulary List - 11-1-15
EMHP 2017 Clinical Focus Formulary List
EMHP 2018 Clinical Focus Formulary List
EMHP 2019 Clinical Focus Formulary List
EMHP Drug Quantity Level Limits (QLL) List - 7-22-14
EMHP Drug Quantity Level List (QLL) - 5-13-15
EMHP Drug Quantity Level List (QLL) - 8-17-15
EMHP Drug Quantity Level Lists (QLL) - 12-3-2014
EMHP Drug Quantity Level Lists (QLL) - 2-17-2015
EMHP Drug Quantity Level Lists (QLL) 9-12-14
EMHP Drug Quantity Level Lists (QLL)
EMHP Drug Quantity Levels List (QLL) - 7-1-16
EMHP Drug Quantity Levels List (QLL) - 11-16-15
EMHP Drug Quantity Levels List (QLL) - 1-8-16
EMHP Drug Quantity Levels List (QLL) 4-1-16
EMHP Intercept Drug List - 1-1-19
EMHP Intercept Drug List_4-1-19
EMHP Limited Distribution Medications - October 2018
EMHP Limited Distribution Medications 1-1-19
EMHP Limited Distribution Medications List - 4-1-19
EMHP Personalized Medicine List - 10-1-16
EMHP Personalized Medicine List - 10-1-18
EMHP Personalized Medicine List - 11-16-15
EMHP Personalized Medicine List - 1-1-2018
EMHP Personalized Medicine List - 12-19-2014
EMHP Personalized Medicine List - 1-8-16
EMHP Personalized Medicine List - 4-1-16
EMHP Personalized Medicine List - 4-1-18
EMHP Personalized Medicine List - 4-1-19
EMHP Personalized Medicine List - 4-1-2015
EMHP Personalized Medicine List - 5-1-15
EMHP Personalized Medicine List - 7-1-16
EMHP Personalized Medicine List - 8-17-15
EMHP Personalized Medicine List 1-1-19
EMHP Personalized Medicine List
EMHP Quantity Level Limits - 10-1-2017
EMHP Quantity Level Limits (QLL) 1-1-19
EMHP Quantity Level Limits (QLL) List - 10-1-16
EMHP Quantity Level Limits (QLL) List - 10-1-18
EMHP Quantity Level Limits (QLL) List - 1-1-2017
EMHP Quantity Level Limits (QLL) List - 1-1-2018
EMHP Quantity Level Limits (QLL) List - 4-1-18
EMHP Quantity Level Limits (QLL) List - 5-1-2017
EMHP Quantity Level Limits List - 4-1-19
EMHP Specialty Prior Authorization List - 4-1-19
EMHP Specialty Prior Authoirzation List
EMHP Specialty Prior Authoization List - 10-1-16
EMHP Specialty Prior Authorization List - 10-1-18
EMHP Specialty Prior Authorization List - 10-1-2017
EMHP Specialty Prior Authorization List - 11-16-15
EMHP Specialty Prior Authorization List - 1-1-2017
EMHP Specialty Prior Authorization List - 1-1-2018
EMHP Specialty Prior Authorization List - 1-8-16
EMHP Specialty Prior Authorization List - 2-17-2015
EMHP Specialty Prior Authorization List - 4-1-16
EMHP Specialty Prior Authorization List - 4-1-18
EMHP Specialty Prior Authorization List - 5-1-2017
EMHP Specialty Prior Authorization List - 5-13-14
EMHP Specialty Prior Authorization List - 5-13-15
EMHP Specialty Prior Authorization List - 7-1-16
EMHP Specialty Prior Authorization list - 8-17-15
EMHP Specialty Prior Authorization List - 8-25-14
EMHP Specialty Prior Authorization List 1-1-19
EMHP Standard and Enhanced Prior Authorization List - 5-13-15
EMHP Standard and Enhanced Prior Authorization Lis-2-17-2015
EMHP Standard and Enhanced Prior Authorization List - 1- 1-2017
EMHP Standard and Enhanced Prior Authorization List - 10-1-16
EMHP Standard and Enhanced Prior Authorization List - 10-1-2017
EMHP Standard and Enhanced Prior Authorization List - 11-16-15
EMHP Standard and Enhanced Prior Authorization List - 12-3-14
EMHP Standard and Enhanced Prior Authorization List - 1-8-16
EMHP Standard and Enhanced Prior Authorization List - 4-1-16
EMHP Standard and Enhanced Prior Authorization List - 5-1-2017
EMHP Standard and Enhanced Prior Authorization List - 7-1-16
EMHP Standard and Enhanced Prior Authorization List - 8-17-15
EMHP Standard Prior Authorization List - 10-1-18
EMHP Standard Prior Authorization List - 1-1-2018
EMHP Standard Prior Authorization List - 4-1-18
EMHP Standard Prior Authorization List - 4-1-19
EMHP Standard Prior Authorization List - 5-13-14
EMHP Standard Prior Authorization List - 8-25-14
EMHP Standard Prior Authorization List 1-1-19
EMHP Step Therapy Drug List - 5-18-16
EMHP Step Therapy Drug List - 10-1-16
EMHP Step Therapy Drug List - 10-1-18
EMHP Step Therapy Drug List - 10-1-2017
EMHP Step Therapy Drug List - 1-1-2017
EMHP Step Therapy Drug List - 1-1-2018
EMHP Step Therapy Drug List - 3-9-2015
EMHP Step Therapy Drug List - 4-1-18
EMHP Step Therapy Drug List - 4-1-19
EMHP Step Therapy Drug List - 5-1-2017
EMHP Step Therapy Drug List - 5-13-14)
EMHP Step Therapy Drug List - 7-1-16
EMHP Step Therapy Drug List - 8-17-15
EMHP Step Therapy Drug List - 9-12-14
EMHP Step Therapy Drug List - 9-24-15
EMHP Step Therapy Drug List 1-1-19
EMHP Step Therapy Drug List 5-13-15
EMHP Step Therapy Drug List
EMHP Step Therapy List - 11-16-15
EMHP Step Therapy List - 1-8-16
EMHP Step Therapy List - 4-1-16
EMHP Wellmanaged Hyperinflationary Drug List - effective 9-1-18
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