Forms

Claim Forms

1. Dental Claim Form
2. Group Medical Claim Form
3. CareMark Prescription Drug Claim Form
4. HDHP Prescription Drug Claim Form
5. Vision Claim Form
6. Life Claim Form
   

Employee Forms

1. COBRA Form PDF
2. Continuation of Coverage for Disabled Dependents Form PDF

DENTAL

1. Interactive Enrollment Card Online
2. Dental Only Enrollment Card PDF
3. Dental/Vision Enrollment Card PDF
4. Refusual of Dental Coverage Form PDF
5. Affidavit of Domestic Partnership Form Word | PDF

MEDICAL

1. Health Solutions II Enrollment Form (National) Online | PDF
2. Health Solutions II Enrollment Form (Texas) Online | PDF
3. HDHP Employee Enrollment Form Online | PDF
4. Idaho Universal Enrollment Form (for all medical plans) Online | PDF
5. CareMark Mail Order Form
6. View a Current Drug List

VISION

1. Enrollment Card Online | PDF
   

LIFE

1. Essential Life Enrollment Form PDF
2. Passport Life Enrollment Form PDF
3. Flex Life Enrollment Form PDF
4. Change of Beneficiary PDF