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.)

    Filter
    All Claims Pension Sick Leave

    Download PDF

    Print PDF

    • Elixir Designation of Personal Representative (Spanish)
    • 2024 Kaiser HIPAA Authorization Form
    • Kaiser/Kaiser Dual Reimbursement Form
    • Medical Benefits (Shingles Vaccination, Hearing Aid, CBD Oil) Reimbursement Form
    • MedImpact Compound Drug Prior Authorization
    • MedImpact Drug Reimbursement Claim Form
    • MedImpact Market Price Drug Exception Request
    • Notice of Return from Armed Forces
    • Overage Disabled Dependent Child Medical Benefits Application
    • PACT Disability Extension Packet
    • PACT Extended Death Benefit Filing Requirements
    • PACT Life and Accidental Death Claim Application