Useful Forms
| Mail Order Form |
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Use this form if you wish to receive your drug prescriptions through the mail. Download the form.
| Mail Completed Form to: |
Prescription Solutions
PO Box 509075
San Diego, CA 91250-9075 |
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| Request for Medicare Prescription Drug Coverage Determination |
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Request for Medicare Prescription Drug Coverage Determination Form
Use this form if you wish to request a coverage determination, including a request for tiering or formulary exception.
| Mail Completed Form to: |
TeamStar Part D
PO Box 8080
McKinney, TX 75070 |
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| Appointing a Representative Form |
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Appointing a Representative Form
If you wish to appoint someone to act on your behalf when requesting a coverage determination, use the Appointing a Representative Form. You can name a relative, friend, advocate, doctor, or anyone else to act for you. Some other persons may already by authorized under state law to act for you. If you want someone to act for you, then you and that person must sign and date this form.
| Mail Completed Form to: |
TeamStar Part D
PO Box 8080
McKinney, TX 75070 |
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updated 12/04/08
This website is intended to provide you with information about Medicare prescription drug coverage so you can make an informed decision about how Medicare Part D can help you manage your prescription drug costs. The International Brotherhood of Teamsters Voluntary Employee Benefits Trust contracts with the federal government and is a Medicare-approved provider of the Part D plan.
