Butler Health Plan
Forms - Butler Health Plan
Butler Health Plan Butler Health Plan Butler Health Plan

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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