Benefits Enrollment/Change Forms

2012 Colleague

2012 Executive/Clinician

2012 Plan Year Forms

Humana Dental Referral Form

Humana Medical Claim Form
(mail completed form to the address on the back of your HumanaAccess card)

Humana Physician Nomination Instructions

Humana Prescription List

Humana RX Claim Form

Humana RX Mail-Order Form (colleague)

Humana RX Mail-Order Form (physician)

Lincoln - Beneficiary Information

Lincoln - Evidence of Insurability Form (instructions)

MetLife Critical Illness Application

2011 Plan Year Forms

401(k) Enrollment Packet - New Hires in 2011

Aetna DMO Claim Form

Aetna DMO Co-pay Schedule - 2011 Plan Yr.

CIGNA Claim Form

CIGNA TelDrug Prescription Classifications

Express Scripts - Prescription Classification 

Express Scripts Temporary ID Card

Express Scripts Claim Form

Express Scripts Mail Order Form

MetLife Dental Claim Form 

Non-Preferred Meds Listing with Alternatives