Tribute Health Plans
A Partnership for Care
Waiver of Liability Tribute Summary of Benefits 2019 Tribute Summary of Benefits 2018 Tribute Step Therapy 2019 Tribute Step Therapy 2018 Tribute Select Summary of Benefits 2023 Tribute Select Summary of Benefits 2022 Tribute Select Summary of Benefits 2021 Tribute Select Summary of Benefits 2020 Tribute Select Pre-Enrollment Checklist 2023 Tribute Select Pre-Enrollment Checklist 2020 Tribute Select Multi-Language 2020 Tribute Select Marketing Presentation 2021 Tribute Select Marketing Presentation 2020 Tribute Select Marketing Flip Chart 2023 Tribute Select Evidence of Coverage 2023 Tribute Select Evidence of Coverage 2022 Tribute Select Evidence of Coverage 2021 Tribute Select Evidence of Coverage 2020 Tribute Select Annual Notice of Changes 2023 Tribute Select Annual Notice of Changes 2022 Tribute Select Annual Notice of Changes 2021 Tribute Select Annual Notice of Changes 2020 Tribute Quantity Limit 2019 Tribute Quantity Limit 2018 Tribute Prior Authorizations 2019 Tribute Prior Authorizations 2018 Tribute Pre-Enrollment Checklist 2019 Tribute Formulary Changes 2019 Tribute Formulary Changes 2018 Tribute Evidence of Coverage 2019 Tribute Comprehensive Formulary 2019 Tribute Comprehensive Formulary 2018 Tribute Complete Application Tribute Annual Notice of Changes/Evidence of Coverage 2018 Tribute Annual Notice of Changes 2019 Tribute Advantage Summary of Benefits 2023 Tribute Advantage Summary of Benefits 2022 Tribute Advantage Summary of Benefits 2021 Tribute Advantage Summary of Benefits 2020 Tribute Advantage Pre-Enrollment Checklist 2023 Tribute Advantage Pre-Enrollment Checklist 2020 Tribute Advantage Multi-Language 2020 Tribute Advantage Marketing Presentation 2021 Tribute Advantage Marketing Presentation 2020 Tribute Advantage Marketing Flip Chart 2023 Tribute Advantage Evidence of Coverage 2023 Tribute Advantage Evidence of Coverage 2022 Tribute Advantage Evidence of Coverage 2021 Tribute Advantage Evidence of Coverage 2020 Tribute Advantage Annual Notice of Changes 2023 Tribute Advantage Annual Notice of Changes 2022 Tribute Advantage Annual Notice of Changes 2021 Tribute Advantage Annual Notice of Changes 2020 Step Therapy 2023 Step Therapy 2022 Step Therapy 2021 Step Therapy 2020 Star Rating 2023 Star Rating 2022 Star Rating 2021 Star Rating 2020 Star Rating 2019 Select Summary of Benefits 2019 Select Step Therapy 2019 Select Step Therapy 2018 Select Quantity Limit 2019 Select Quantity Limit 2018 Select Prior Authorizations 2019 Select Prior Authorizations 2018 Select Pre-Enrollment Checklist 2019 Select Formulary Changes 2019 Select Formulary Changes 2018 Select Evidence of Coverage 2019 Select Comprehensive Formulary 2019 Select Comprehensive Formulary 2018 Select Annual Notice of Changes 2019 Scope of Appointment 2023 Scope of Appointment 2021 Scope of Appointment 2020 Scope of Appointment 2019 Request for Access to PHI Quantity Limit 2022 Quantity Limit 2021 Quantity Limit 2020 Provider Authorization and Referral List 2021 Privacy Complaint Form Prior Authorization List 2021 Prior Authorization List 2020 Prior Authorization Form 2021 Prior Authorization Form 2020 Pharmacy Prior Authorization 2023 Pharmacy Prior Authorization 2022 Pharmacy Prior Authorization 2021 Pharmacy Prior Authorization 2020 Part B Drug Prior Authorization List 2022 Part B Drug Prior Authorization List 2020 Notice of Privacy Practices Multi-Language Services Medication Transition Policy 2023 Medication Transition Policy 2022 Medication Transition Policy 2021 Medication Transition Policy 2020 Medication Transition Policy 2019 Medication Therapy Mangement 2019 Medication Therapy Management 2023 Medication Therapy Management 2022 Medication Therapy Management 2021 Medication Therapy Management 2020 Marketing Presentation 2019 Horizons Step Therapy 2018 Horizons Quantity Limit 2018 Horizons Prior Authorizations 2018 Horizons Formulary Changes 2018 Horizons Comprehensive Formulary 2018 Formulary Changes 2023 Formulary Changes 2022 Formulary Changes 2021 Formulary Changes 2020 Formulary 2023 Formulary 2022 Formulary 2021 Formulary 2020 Enrollment Form Cover Sheet 2023 Enrollment Form Cover Sheet 2020 Enrollment Form Cover Sheet 2019 Enrollment Form 2022 Enrollment Form 2021 Enrollment Form 2020 Enrollment Form 2019 Disposal of Unused Prescriptions Disenrollment Form 2023 Disenrollment Form Coverage Redetermination 2023 Coverage Redetermination 2022 Coverage Redetermination 2021 Coverage Redetermination 2020 Coverage Redetermination 2019 Coverage Determination 2023 Coverage Determination 2022 Coverage Determination 2021 Coverage Determination 2020 Coverage Determination 2019 Clinical Practice Guidlines 2018 Clinical Practice Guidelines 2020 Clinical Practice Guidelines 2019 Authorization to Disclose PHI Anti-Discrimination Notice Anti-Discrimination 2020 AMC Dental Application 2023 Tribute Select Prior Authorization Form 2023 Tribute Select Prior Authorization and Referrals List 2023 Tribute Advantage Prior Authorization Form 2023 Tribute Advantage Prior Authorization and Referrals List 2023 Part B Prior Authorization List 2023 Enrollment Form 2022 Tribute Select Prior Authorization Form 2022 Tribute Select Prior Authorization and Referrals List 2022 Tribute Select Pre-Enrollment Checklist 2022 Tribute Select Marketing Flip Chart 2022 Tribute Advantage Prior Authorization Form 2022 Tribute Advantage Prior Authorization and Referrals List 2022 Tribute Advantage Pre-Enrollment Checklist 2022 Tribute Advantage Marketing Flip Chart 2022 Enrollment Form 2022 Breathing Better Resource Pages 2021/2022 Provider Manual 2021 Breathing Better Resource Pages 2019 Provider Manual
