Forms & Resource Center
The Forms & Resource Center contains some of the commonly used forms for our health plan members. These forms are for use across many plans and are therefore generic in presentation. For the most up to date forms that may have been customized for your unique health plan we invite you to register for an account by visiting the Members page.
Online Document Submission
Below are a collection of forms you can click on to print, should you require assistance or have questions please do not hesitate to call:
- OTC COVID Test Claim Form
- Medical Claim Form
- Dental Claim Form
- Vision Claim Form
- COB Questionnaire
- Subrogation/Assignment Form & Authorization of Release
- FSA Claim Reimbursement Form
- Dependent Care FSA Reimbursement Form
- HRA Reimbursement Claim Form
- Transit Claim Form
A PDF viewer is required to view this forms, if your computer does not have a PDF viewer you can download Adobe PDF Reader here.