Forms & Resources
We are committed to keeping you up-to-date on all aspects of your benefit plan. Whether you need to request a new ID card for an employee or download an important form, you can find it all here.
Would you like to:
Download the Administrative Guide 
Order an ID Card or print a temporary card for a member
Forms for Employers
COBRA Enrollment
Forms for Members
Online Access / PHI Disclosure Form
Member Authorization to Obtain PHI
Member Authorization to Release PHI
Transition of Care Request Form
Member Appeal
Request for Network Exception
Network Exception Request Form
Member Reimbursements*
Member Reimbursement Form 
submit your request in My Plan
Travel Reimbursement Form submit your request in My Plan
Verifications
Out-of-Area Dependent Coverage Verification Form
*Claim and reimbursement forms may not be applicable to all plans. Be sure to check your benefit details in your summary plan description prior to submitting a claim or reimbursement form.
Some forms on this page are in PDF format and require Adobe Reader to open.
