Medical cannabis pre-authorization form
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If you have coverage through your employer or plan sponsor, use our workplace benefits insurance forms. If you have coverage through an advisor, use our personal insurance forms.
Request pre-approval
Use this form to request approval for medical cannabis coverage.
Step 1: Complete a form.
Download the form and print it, or fill it out in Adobe Reader XI or higherOpens a new website in a new window - Opens in a new window (not your browser) and save. Complete the plan member section.
Use this form to request approval for medical cannabis coverage. You’ll need the doctor to fill in some sections.
Step 2: Ask your doctor to complete the physician information section.
Step 3: Submit your request for approval.
You’ll find instructions on how to submit your request on the form itself.