The following forms are available in Adobe Acrobat Portable Document Format (PDF). If you do not have Acrobat Reader installed on your system, you may download it by clicking on the "Get Acrobat Reader" icon.

To print a form

1. Select the desired form by clicking on the form title you desire.
2. Once in Acrobat Reader, click on the printer icon.
3. Click OK once you have selected the desired printer.

To save the form in Acrobat Reader format

1. Select the desired form by clicking on the form title you desire.
2. Select the floppy disk icon.
3. Chose the destination directory and the file name that you want to save the file as.
4. Click on the Save button.

Forms

Group Enrollment/Change Form

Group Medical Claim Form

Group Dental Claim Form

Group Vision Claim Form

Flexible Benefits Enrollment/Change Form

HRA Claim Form

Flexible Benefits Plan Claim Form

Claims - Pre Cert Form

Claims - Request of Accident Details

Claims - Request for Accident Information (Spanish)

Claims - Request for Other Insurance Information

Claims - Request for Other Insurance Information (Spanish)

Claims - Request for Primary EOB/Secondary EOB

Claims - Request for Student Status

Claims - Request for Student Status (Spanish)

Authorization to Obtain Records

Authorization to Obtain Medical Records (Spanish)

Request for HIPAA Certificate

Names of Physicians Seen

Request for Physicians Seen (Spanish)