Forms

Vision Claim Form – Preferred Benefit Administrators

Need to file a vision claim? Use this form to file directly with Preferred Benefit Administrators (PBA).

Voya Additional Term Life Insurance Enrollment Form

If you want to enroll in Voya Additional Term Life Insurance, use this form.

Flexible Spending Account Enrollment Form

Use this form when enrolling in Flexible Spending Accounts.

Short-Term Disability Calculator

This worksheet helps you figure out the cost of disability insurance.

Florida Blue – Out-of-State Medical Claim Form

Use this form to file medical claims that occur out-of-state.

Express Scripts Direct Claims Form

This form is used to be reimbursed for prescriptions.

Humana PHI Form

Humana PHI Form

Humana Dental Claim Form

Humana Dental Claim Form

FRS Beneficiary Form

FRS Beneficiary Form