Use the links below to print/view copies of our most frequently used forms.

Health-Related Forms

Prescription Claim Forms

For compound drugs to be considered for reimbursement by the plan, each ingredient of the compound must be found and payable in our claims system. Members who choose to pay out-of-pocket for compounded drug products will not be reimbursed if the compound contains an ingredient that is not able to be identified and payable in our claims system.

Claim Forms

FSA, HRA, and HSA Reimbursement Forms

Membership & Enrollment Forms

Form 1095-B

Taxpayers are not required to include a Form 1095-B when filing their taxes.

Health insurers are no longer required to mail Form 1095-B to their members.

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