Here you’ll find information that can help you manage your plan, plus other resources. If you can’t find a form below, you can also
- Medical coordination of benefits form (PDF)
- Travel benefit claim form (PDF) (certain plans only)
- Dental coordination of benefits form (PDF)
- Dental out-of-network reimbursement form (PDF) (Medicare plans only)
- Pharmacy claim form (PDF)
- Pharmacy prior authorization/exception request form (PDF)
- Information about Medicare drug coverage initial determinations and redeterminations
- Minnesota uniform prior authorization and formulary exception form (PDF)
- Pharmacy site of care request for information form (PDF)
- Short-term health plan prescription claim review form (PDF)
- FSA/HRA claim form (PDF)
- Direct deposit form (PDF)
- Automatic claims submission opt-out request form (PDF)
- Letter of medical necessity form (PDF)
- Dependent care expense claim form (PDF)
- Transportation and parking expense claim form (PDF)
- Spending account enrollment/election form (PDF)
You can also learn more about FSAs and other reimbursement accounts, or learn more about HRAs.
Employer forms
If you’re an employer, see our