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Medical cannabis pre-authorization form

Have coverage through your employer or plan sponsor? You’re in the right place.

If you bought coverage through your advisor, use our personal insurance forms instead.

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.

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 claim on the form itself.

Not what you’re looking for? Find the forms you need.

I have coverage through my employer

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I bought coverage through an advisor

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