Creating Healthier Benefits SM

Standard Forms   Other Coverage Verification Form   -   Executed online through Citrix's RightSignature   Student Status Form   -   Executed online through Citrix's RightSignature   Accident Information Form   -   Executed online through Citrix's RightSignature   Authorization For Release Of Information Form   -   Executed online through Citrix's RightSignature   Lost Check Agreement    -   Executed online through Citrix's RightSignature   Continuity of Care Request Form   Uniform Glossary of Health Coverage and Medical Terms   Medical Claim Form - HCFA 1500   Dental Claim Form   -   Executed online through Citrix's RightSignature   Dental Claim Form   Vision Claim Form   -   Executed online through Citrix's RightSignature   Vision Claim Form   Disability Claim Form Section 125 Cafeteria Plans / Flexible Spending Accounts / Health Reimbursement Arrangement   Flexible Spending Account Claim Form   Request Form for Issuance of Additional Flex Debit Cards   Health Reimbursement Arrangement (HRA) Claim Form   Over-the-Counter Medicines - Quick Reference Guide General Information   No Surprises Act - Understanding your rights and protections from surprise medical bills   COVID-19 OTC Home Test Reimbursement FAQ - Magellan RX Members   COVID-19 OTC Home Test Reimbursement FAQ - Optum RX Members   COVID-19 OTC Home Test Reimbursement FAQ - Southern Scripts Members   COVID-19 OTC Home Test Reimbursement FAQ - CVS Caremark Members   Services Provided by Interactive Medical Systems Machine Readable Files   Interactive Medical System's Website for Machine Readable Files