Forms and Brochures
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To view or download a file below, click the topic heading, then click the desired document link. The PDF file will open in a new window or tab of your browser. From there, you can also download or print the file.
- Medical Claim Form (PDF)
Complete the claim form for each member submitting bills for reimbursement of covered services. To avoid any delay, be sure to answer each question completely. PLEASE ATTACH FULLY ITEMIZED BILLS AND PROOF OF PAYMENT.
- Coordination of Benefits Form (PDF)
- Out-of-Network Vision Claim Form (PDF)
- Wellness PayBack Claim Form (PDF)
- Prescription Drug Claim Form (PDF)
- 2019 Enrollment Form - English (PDF)
- HSA for Life - Enrollment Packet (PDF)
- Disabled Dependent Certification Form (PDF)
Glossary of Health Coverage and Medical Terms (PDF)
Glossary of Health Coverage and Medical Terms - Spanish (PDF)
Glossary of Health Coverage and Medical Terms - Chinese (PDF)
Glossary of Health Coverage and Medical Terms - Korean (PDF)
Glossary of Health Coverage and Medical Terms - Navajo (PDF)
Health insurance companies and group health plans are required to make available a uniform glossary of health coverage and medical terms commonly used in plan documents. The Uniform Glossary is meant to help the consumer understand some of the most common language used in health insurance documents. Please log in to request a hardcopy of the document by mail.