Forms

Enrollment Form
To download the current enrollment form for your school please click here.

Claim Form
Used by you or your doctor, to submit a claim for benefits or a prescription drug reimbursement (for those policies which have MEDCO Rx Discount Program).
Download form

Health Allies
To download the Health Allies brochure please click here.

MEDCO Claim Form
Used for reimbursement of prescription drugs for those policies using the MEDCO network of pharmacies.
Download form

Specific Case Authorization Form
This form gives us permission to discuss a specific medical condition you might have with a designated person of your choice.
Download form

Yearly Authorization Form
This form gives us permission to discuss any and all medical conditions you might have with a designated person of your choice, throughout the school year.
Download form

Privacy Notice
This form gives you information on how we handle and protect your privacy regarding any medical condition.
Download form

Travel Assistance
This brochure gives you information you need to access our Travel Assistance Services when you travel.
Download form
Download ID card