Access Forms
We are committed to keeping you up-to-date on all aspects of your benefit plan. Whether you need to request a new ID card for an employee or download an important form, you can find it all here.
Would you like to:
Order an ID Card or print a temporary card for a member?
Forms for Employers
COBRA Enrollment
Forms for Members
Online Access / PHI Disclosure Form
Member Authorization to Obtain PHI
Member Authorization to Release PHI
Transition of Care Request Form
Member Appeal
Member Reimbursements
Member Reimbursement Form 
submit your request in My Plan
Fitness Reimbursement Form submit your request in My Plan
Travel Reimbursement Form submit your request in My Plan
Verifications
ElevateHealth Out-of-Area Dependent Coverage Verification Form
Some forms on this page are in PDF format and require Adobe Reader to open.
