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Medical cannabis pre-authorization form

Have coverage through your advisor? You’re in the right place.

If you have coverage through your employer or plan sponsor, use our workplace benefits 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 request 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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