The time to sign-up for your 2026 Schwab Insurance Medicare plan is October 15–December 7.
You can view and download important forms and policies related to your plan.
Click below to access the forms that authorize the sharing of your Protected Health Information (PHI). Each form will have instructions on how to submit.
Use this form allow people like your spouse, child, other family member or trusted friend, to discuss your health insurance benefits or healthcare with Schwab representatives.
Access Form
Use this form to ask Schwab Health to use different contact information, such as a phone number, mailing address, email address, or another method(s) of contact, when we communicate with you about your PHI.
Access Form
Use this form to request a report called an “accounting of disclosures” that tells you when and why your PHI was shared for certain purposes.
Access Form
Use this form to ask Schwab Health to restrict the use or disclosure of your PHI for certain aspects of treatment, payment, or healthcare operations.
Use this form to appoint a representative to act on your behalf for your claim, appeal, grievance or request. By signing this form and appointing this representative, you agree that the representative will be the main contact and have authority to make requests, present evidence, get information, and receive all communication about your action. This person may see your personal medical information.
Access Form
Use this form to ask for a copy of your PHI from Schwab Health to be sent to you or to another person, such as a family member. These records include medical and billing records.
Access Form
Use this form to request a correction (amendment) to the information in your health records that are maintained by Schwab Health.
Click below to access forms for billing and reimbursements. Each form will have instructions on how to submit.
Use this form to authorize Medicare to automatically deduct your monthly premiums from your bank account.
A Part D Late Enrollment Penalty (LEP) Reconsideration Request form is used to challenge a late enrollment penalty assessed on a Part D prescription drug plan. Use this form to appeal the penalty if you believe it’s incorrect or if extenuating circumstances apply, such as having continuous creditable coverage or experiencing a medical emergency that prevented timely enrollment.
Use this form to request reimbursement for out-of-pocket expenses for treatments that are covered under your Medicare plan but were not paid for by your Medicare plan.
Access Medical Services Form
Access Dental Services Form
Access Vision Services Form
Use this form to request reimbursement for out-of-pocket expenses for medications that are covered under your Medicare plan but were not paid for by your Medicare plan.
Quick tip: For an easy claim submission process and a faster claim decision turnaround time submit requests for reimbursement of member-paid prescriptions online via Caremark web portal (Caremark.com) and the Caremark mobile app (available for Android and Apple).
Follow the link below if you need to appeal a decision or make a complaint.
Medical Organization Determinations,Prior Authorizations, Grievances, and Appeals
Part D Coverage Determinations, Exceptions, Grievances, and Appeals
Prescription Drug Transition Policy
Out-of-Network Coverage Policy
How to get Extra Help for Medicare Prescription Drug Coverage – Georgia
How to get Extra Help for Medicare Prescription Drug Coverage – New Jersey
How to Disenroll from Schwab Insurance Group
Quality Assurance and Drug Management Programs
Consent for Recurring Mailing of Prescriptions Follow Up Call
Changes to Diabetic Testing Supplies