Forms

Use this form to file a medical claim in order to be reimbursed for all covered medical benefits which you have already paid out of pocket.

Use this form to file a medical claim in order to be reimbursed for all covered prescription benefits which you have already paid out of pocket.

The Authorization to use or disclose health Information form gives us permission to discuss only the specified medical condition with your Personal Representative, and/or specific groups and organizations as indicated on the form.

The Personal Representative Appointment Form gives us permission to discuss any and all medical conditions with your Personal Representative, throughout the school year.This form is filled out once and is good for every injury/sickness for the entire school year.

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