transforming risk into opportunity
FORMS
Please select and download the forms you need. If you do not have Adobe Reader,
you can download it here.
you can download it here.
BENEFIT ADMINISTRATION
- Flexible Spending Account Enrollment Form
- Flex Claim Reimbursement Form
- Health Reimbursement Arrangement Claim Form
- Prescription Drug Claim Form
- Vision Claim Form
- Employee Benefit Enrollment Form
- Medical/Dental Enrollment Update Form
- FSA-HRA Enrollment Update Form
- Proof of Disabled Child Form
- Dental Claim Form
- Accident Questionnaire
- Coordination of Benefits Form
- Enrollment Full-time Student Verification Form
- Flex Card Expense Substantiation Form
- Other Insurance and Dependent Coverage Questionnaire
- Glossary of Health Coverage and Medical Terms
- Medical Claim Form
DISABILITY
- Attending Physician Disability Statement
- Employee Disability Statement
- Employer Disability Statement
- HIPAA Authorization
- FMLA Fitness for Duty Certification
- Certification of Healthcare Provider
- Employer PFL Report
- Employee Application for PFL Benefits
- Employee PFL Bonding Certification
- PFL Attending Physician Certification
- PFL Statement of Care Recipient