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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    • UEBT Active Annual Verification Enrollment Packet
    • UEBT Active Extended Medical Benefits
    • UEBT Active Other Insurance Information (OII) Form
    • UEBT Active Premier Enrollment Packet
    • UEBT Active Ultra Enrollment Packet
    • UEBT Elixir Market Price Drug Exception Request
    • UEBT Extended Death Benefit Filing Requirements
    • UEBT Life and Accidental Death Claim Application
    • UEBT Preventive Care Guidelines 2022
    • UEBT Request for Transfer of Eligibility Credits
    • Uprise Health (HMC) Claim Submission Form