---

Non-Medicare Prescription Plan

Appeal Process

• CVS Caremark non-Medicare Prescription Plan Appeal Process
• To request a review or appeal the processing of claims for prescription services, member must complete the following two forms and submit to the Statewide Benefits Office:
  • * State of Delaware Authorization for Release of Protected Health Information Form
  • * Appeal Form and Checklist for Filing a Level III Appeal of Prior Denial to SBO
• Highmark Delaware Appeal Process for non-Medicare Health Plans
• Aetna Appeal Process for CDH Gold and HMO Health Plans
• Lantern Appeal Process

*Note: This document has functionality that doesn't work in a browser. The PDF will automatically download and you must open the PDF from your downloads folder into Adobe Acrobat.

---