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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    • Medical Benefits (Shingles Vaccination, Hearing Aid, CBD Oil, COVID OTC) Reimbursement Form
    • Medicare Advantage Reimbursement Claim Form and Instructions
    • 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
    • PACT Request for Transfer of Eligibility Form
    • Participant Account Registration Quick Reference