Skip to main content

Request an information kit

Each kit contains helpful details about your selected plan‘s benefits and covered drugs, along with other important information.


Please complete the form below so we can mail you an information kit for ${orderKitPlanKitName}. Please allow 7 to 15 business days for delivery.

All fields marked with an asterisk (*) are required.

WANT TO SEND A KIT TO ANOTHER PERSON OR ADDRESS? (Check the box to add the recipient’s information below.)