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Employer Forms & Resources

Download and print commonly used forms. All forms are in PDF format. Download Acrobat Reader.

Employer Forms

FORM
DESCRIPTION
Medical Claim Form
Use this form to file a claim for medical services, such as office visits, physical therapy, laboratory services and radiology services such as X-rays.
Transaction Transmittal
Use this form to notify us of a name or address change, or to cancel, transfer or reinstate an employee’s coverage.
 
 

FlexShare Forms

FORM
DESCRIPTION
Premium Only Plan (POP)
Enroll an employee in a Premium Only Plan.
 
 

Member Forms

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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