Online and PDF Forms
Below is a list of online and downloadable PDF forms. Online forms can be filled out directly through this website. PDF forms can either be downloaded and filled out using your PDF viewer, or within the browser.
Employee / Member
CEBT HIPAA Documents
Caremark (prescription drug coverage provider)
Prescription Drug Mail Order Form
Prescription Drug Standard Claim Form
UMR
UMR Possible Third Party Liability Form
Delta Dental
VSP
Vision Care Out of Network Reimbursement Form
*You could also submit your claim online at vsp.com
Standard Insurance Company
Basic & Voluntary Life Portability Application
Voluntary Life Medical History Statement
Employer / Payroll / Human Resource
CEBT
Evidence of Group Health Coverage
General
Affidavit of Common Law Marriage