Member Resources

To help make it easier for you to find the forms you need, we’ve provided quick access to the following frequently used forms, all in one convenient location:

Medical, Dental, Vision Resources

• Dental Claim Form
• Medical Claim Form
• Vision Claim Form
• Appeal Filing Form

Reimbursement Account Resources

• HSA Claim Form
• FSA FAQ
• FSA/HSA Eligibility List
• FSA/HRA Medical Claim Form
• FSA Dependent Care Claim Form
• FSA Store
• Transportation Account Reimbursement Claim Form

HIPAA Authorization Forms

• Authorization to Disclose Protected Health Information (PHI)
• Authorization to Release Medical and HIV Related Information