The forms listed on the menu below are for use by members. These forms are in portable
document format (PDF). You may print and copy as needed.
Note: Some employers
use customized forms or electronic systems. Please check with your Human Resources
When you sign up for our free, pre-authorized monthly bank draft program you don’t
have to write checks, keep bills or buy stamps. Bills are paid even when you’re
away, and there is never a risk of a lapse in coverage.
Use these forms to request a change to your current policy, such as name changes,
deductible amounts, dependent status and more.
We want to pay your eligible claims as fast as possible, so use these forms to submit
These printable forms allow you to exercise your privacy rights in the most efficient
manner. By printing, completing and sending these forms to the Privacy Office, your
request will be processed efficiently because we will have the information needed
to fulfill the request.