Office Supplies

Forms

Forms
Dental
Dental Claim Form Download
Flexible Spending Accounts
FSA Claim Form Download
FSA Claim Instructions Download
FSA Direct Deposit Authorization Download
HIPAA Authorization 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
Lucent Health HRA Direct Deposit Form Download
Lucent Health 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
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.



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.

This is the Life is a registered service mark of Woodmen of the World Life Insurance Society.