| Forms | |
| Dental | |
| Dental Claim Form | Download |
| Health | |
| BCBS Claim Form | Download |
| BCBS HIPAA Authorization | Download |
| BCBS Rx Claim Form | Download |
| BlueCard Worldwide International Claim Form | Download |
| Prime Speciality Order Form | Download |
| PrimeMail Order Form | Download |
| HRA - Health Reimbursement Arrangement | |
| Cypress HRA Direct Deposit Form | Download |
| Cypress HRA Reimbursement Form | Download |
| HSA - Health Savings Account | |
| HSA Account Closure Form | Download |
| HSA Beneficiary Designation Form | Download |
| HSA Enrollment Verification Form | Download |
| Retirement | |
| Empower Beneficiary Form | Download |
| Tax Reports | |
| Tax Form 1095-C | View Details |
| Well-being Program | |
| Biometric Screening Certification Form | Download |
| 2016-2017 Wellness Program Appeal | Download |
| Well-being Reimbursement Instructions & Form | Download |
If you need a form not listed here, please contact Human Resources to request it.
Terms and Conditions |
Customer Privacy Notices |
NY Residents
The information on this page is a partial description of benefits, limitations, exclusions, and other provisions of the group benefits provided by Woodmen of the World Life Insurance Society (WoodmenLife). If there is a difference between the information in this summary and the plan document for each plan, the
plan documents
govern. Eligibility requirements apply to each of the benefits offered, criteria may include employment status and/or individual qualifications. For more detailed information, refer to the Summary Plan Description of each plan. WoodmenLife may amend these plans at any time. The description of the plan is not a guarantee of benefits and should not be construed as such.
Fraud, Ethics and EEO Anonymous Hotline: 1-844-339-3053
WoodmenLife.ethicspoint.com
This is the Life is a registered service mark of Woodmen of the World Life Insurance Society.
A+ Financial Rating
This company was issued a secure rating by the A.M. Best Company, click for additional details WoodmenLife® has been awarded a rating of A+ (Superior), the second highest ranking out of 15, for its financial strength and operating performance in 2018 by A.M. Best, one of the nation's leading independent rating organizations.