Member Forms

• Authorization on to Release Information
• Dental Claim Form
• Flex Account Claim Form
• Flex Direct Deposit Form
• Medical Claim Form
• HRA Reimbursement Claim Form

Fully Insured Member Forms

• You are a member on a Fully Insured plan if the Group Number on your ID card will be 6 digits, with no letters.
• Change Request Form
• Transition of Care Form
• Employee Dental Enrollment Form
• Employee Vision Enrollment Form