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)
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