Member Forms

To submit claims for medical care and services.

To submit claims for prescription drugs.

To submit claims for dental care.

Use this form to extend coverage for an adult child on your plan.

To submit claims for prescriptUse this form to certify enrollment of a dependent in secondary or higher education.

Use this form to maintain coverage for a disabled adult dependent.

Questionnaire if you or your dependents are covered by more than one health plan.