Creating Healthier Benefits SM

Standard Forms   Other Coverage Verification Form   -   Executed online through Citrix's RightSignature   Student Status Form   -   Executed online through Citrix's RightSignature   Accident Information Form   -   Executed online through Citrix's RightSignature   Authorization For Release Of Information Form   -   Executed online through Citrix's RightSignature   Lost Check Agreement    -   Executed online through Citrix's RightSignature   Uniform Glossary of Health Coverage and Medical Terms   Medical Claim Form - HCFA 1500   Dental Claim Form   -   Executed online through Citrix's RightSignature   Dental Claim Form   Vision Claim Form   -   Executed online through Citrix's RightSignature   Vision Claim Form   Disability Claim Form Section 125 Cafeteria Plans / Flexible Spending Accounts / Health Reimbursement Arrangement   Flex Claim Form   Request Form for Issuance of Additional Debit Cards   Health Reimbursement Arrangement (HRA) Claim Form   Health Savings Account - HSA Bank Welcome Kit   Health Savings Account - Avidia Welcome Kit   Health Savings Account - Avidia CIP Verification Process   Over-the-Counter Medicines - Quick Reference Guide   Uniform Glossary of Health Coverage and Medical Terms General Information   Services Provided by Interactive Medical Systems