Forms and Resources
Forms
- LSU First Enrollment Form: GB-01
- Medical Claim Form (WebTPA)
- Prescription Drug Claim Form (MedImpact)
- First Choice Provider Nomination Form
- Aetna ASA Provider Nomination Form
- LSU First Prior Authorization Form
- WebTPA HIPAA Form
- MedImpact Rx HIPAA Form
- Certification of Adult Dependent Form
Resources
| General Resources | Annual Notices | 2022 Plan Information |
|---|---|---|