If there is a provider that you are seeing now, that isn't listed in our network search or there aren't any providers close to you, please use the Provider Nomination Form to request that they be added to our network. You can download the form at the bottom of this article and follow the instructions on the form. Or if you would like, you can find this form while on your benefits page.
On your benefit page, select the type of provider you want to see.
Select forms.
Scroll down and select "view form" on the Provider Nomination Form.
Print the form and fill it out.
Send it to us by mail, fax, or email.
Please allow 4-6 weeks for processing. You can reach us at the number or email above if you have additional questions.