Find Forms and Documents

File a Claim

Health Benefits Claim Form
Claim Appeal Form
Vision Claim Form
Prescription Reimbursement Request Form
Mail Order Prescription Form

Other Forms

Designation of Authorize Representative to Appeal Form
Request Continuation of Care From a Non-Network Provider
HIPAA Authorization Form

If you are looking to file a health or dental claim, you can do so by logging into My Health Toolkit. Once logged in, look under Claims & Authorizations and select File a Claim to get started.