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Benefit Forms

Below are links to benefit forms that you can download, print and fill out.

  • Address Change Form
  • Beneficiary Designation Form
  • Caremark Mail Order Form
  • Caremark Claim Form
  • Contact List
  • Dependent Care Spending Account Form
  • Designation of Authority
  • Flexible Spending Account Reimbursement
  • Health Reimbursement Arrangement (HRA) Claim Form
  • HIPAA formĀ 2020
  • Medical Pretreatment Estimate Form
  • Member Communication/Complaint Form
  • Municipal Preferred Providers
  • Travel Expense Voucher
  • Travel Preauthorization Form (Trust Fund)
  • Vision Service Plan Out of Network Reimbursement Form
  • Zenith Medical/Dental Claim Form

Click Here to read the latest Health Trust Newsletter

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