2022 Plan Year Documents for Farm Bureau Select RX

• Summary of Benefits
• Annual Notice of Change (ANOC)
• Evidence of Coverage
• Pharmacy Directory
• Comprehensive Formulary
• Prior Authorization Criteria
• Step Therapy Criteria
• Quantity Limits Criteria
• 2022 LIS Premium Summary
• CMS Star Ratings
• 2022 Enrollment Form

2022 Plan Year Documents for Farm Bureau Essential RX

• Summary of Benefits
• Annual Notice of Change (ANOC)
• Evidence of Coverage
• Pharmacy Directory
• Comprehensive Formulary
• Prior Authorization Criteria
• Step Therapy Criteria
• Quantity Limits Criteria
• 2022 LIS Premium Summary
• CMS Star Ratings
• 2022 Enrollment Form

2022 Other Forms & Documents

• Member Reimbursement Drug Claim Form
• Appointment of Representative Form
• Coverage Determination Request Form
• Request for Redetermination
• Request for Reconsideration
• SSA Extra Help Information
• Personal Medication List

2022 Premium Billing/Payment

• Premium Payments FAQ
• Bank Withdrawal Form
• Credit Card Authorization Form