| 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.