At times, managing your health and your finances requires the sharing of information with some of our partners. Take note of the following forms for your convenience.

• 2025 Medicare Part D Instructions / Reimbursement Claim Form

• International Claim Form

• HIPAA Authorization to Release Information

• UCR Form

• Manual Accident Form

• Out-of-Network Claim Form (Active and Pre-Medicare Retiree only)

• Medicare Claim Form

• Domestic Partner Enrollment Materials

• OTR Form (Mental Health)

• OTR Letter

• Disabled Dependent Form

• COB Instructions and Form

Notice of Privacy Practices