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
Forms for Members
Online Access / PHI Disclosure Form
Member Authorization to Obtain PHI
Member Authorization to Release PHI
Transition of Care Request Form
Request for Network Exception
Network Exception Request Form
Member Reimbursement Form submit your request in My Plan
Travel Reimbursement Form submit your request in My Plan
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.