The forms below will be of use to those insured through Bethany Benefit Service (Express Scripts).





2019 Formulary – Download now
Specialty Pharmacy Flyer – Download now

Home Delivery flyer – Download now
Home Delivery check-list – Download now


Claim Form – Download now
Express Scripts Medicare D Information Outline – Download now
Express Scripts Medicare D Claim Form – Download now

Livongo Flyer – Download now


Contact Bethany Benefits and Covenant Pension with any related questions.
email: bethany(at)covchurch.org  |  phone: (800) 313-8955  |  fax: (773) 784-2249