These forms are in pdf format and can be printed from your printer. However, it requires Acrobat Reader. Click the link below for the form that you wish to print. If you do not see the document, click here to get Acrobat Reader.
Enrollment/Change Form - click here
Spouse - COB Questionnaire - click here
Medical Claim Form - click here
Dental Form - click here
Understanding Your ID Card - click here
Understanding Your Explanation of Benefits (EOB) - click here
Healthspan Personal Health Coach - click here
Caremark Direct Member Reimbursement Claim Form - click here
You may send prescription claims incurred in 2008 to Caremark
until March 31, 2009.
Express Scripts Prescription Drug Claim Form for 2009 - click here
Express Scripts Preferred Drug List Effective January 1, 2009 - click here
Express Scripts Maintenance Medication List 2009 - click here