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SSMP Benefit Materials

The Handbook and the forms are available in Adobe PDF format.  If you don't have Acrobat Reader you can download it from Adobe's web site.


SSMP Handbook

  • Senior Service Medical Plan (SSMP) Handbook

SSMP Claim Forms

  • SSMP Claim Form (Services within the United States)
  • SSMP Prescription Claim Form (Services in the United States)
  • SSMP Medical Claim Form (Services outside the United States)
  • SSMP Prescription Claim Form (Services outside the United States)
  • Information on exchange rates for services outside the United State

SSMP HIPAA Forms

  • Authorization to Use and/or Disclose Protected Health Information
  • Medical Privacy Notice

SSMP Pharmacy

  • VRx Pharmacy Prescription Form

For more information, please contact the Senior Service Medical Plan.

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