Forms Directory
See below for a general list of forms that can be downloaded or printed. Please use the search bar or filter buttons to find a specific form. (Some forms may only be found behind your secure participant login.)
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Domestic Partner Declaration of Dependency for Tax Purposes
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Elixir Compound Drug Prior Authorization
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Elixir Designation of Personal Representative (English)
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Elixir Designation of Personal Representative (Spanish)
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Elixir Drug Reimbursement Claim Form
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2024 Kaiser HIPAA Authorization Form
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Kaiser/Kaiser Dual Reimbursement Form
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Medical Benefits (Shingles Vaccination, Hearing Aid, CBD Oil, COVID OTC) Reimbursement Form
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Notice of Return from Armed Forces
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Overage Disabled Dependent Child Medical Benefits Application
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Personal Information Change Form - Health and Welfare
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Prudential - Notice of Conversion Privilege Form