Medical:
Premera
Medical Expense Claim Form
Premera
Prescription (Rx) Claim Form
Premera Medco by Mail Order Form
Premera Community Wellness Reimbursement Form
Health Insurance Waiver Form
Read carefully prior to completion and submission to HR
Dental:
WDS Dental
Claim Form
Vision:
VSP
Vision Claim Form
Must contact VSP prior to use: 1-800-877-7195
Flexible Spending Accounts (FSAs):
For health and dependent care expenses
FSA's are administered by Benefit Administration
Company (BAC) |
Forms
may be printed or filled-in online |
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Long Term Care Insurance:
Long Term Care - Evidence of Insurability
Additional Life and AD&D Insurance:
Additional Life Insurance/AD&D: Enrollment and Change Form (also allows you to designate or change beneficiaries)
Medical History Statement
Termination or Reduction of Insurance Form