Creating Healthier Benefits
SM
These documents were created using Adobe Acrobat. Need a copy of Adobe Acrobat Reader?
Click Here!
Standard Forms
Medical Claim Form - HCFA 1500
Dental Claim Form
Vision Claim Form
Disability Claim Form
Section 125 Cafeteria Plans / Flexible Spending Accounts
Flexible Spending Account Claim Form
Flex Enrollment Form
Request Form for Issuance of Additional Flex Debit Cards
Health Care FSA Medical Necessity Submission Form
Over-the-Counter Medicines - Quick Reference Guide
General Information
Services Provided by Interactive Medical Systems