Qualifying Life Event | Details on QLE Enrollment | Download Link
HIPAA Release Form | Member’s Authorization to Release Information| Download Link
Student Claim Form | Student Insurance Claim Form | Download Link
Coordination of Benefits Questionnaire | Form when students have other insurance | Download Link
Accident/Injury Questionnaire | Healthcare services related to an accident/injury | Download Link
Travel Medical Claim Form | Healthcare services related to traveling overseas | Download Link
Wellfleet Rx Prescription Reimbursement Form | Form for Wellfleet Rx prescriptions | Download Link
Cigna Prescription Reimbursement Form | Form for Cigna prescriptions | Download Link
Optum Rx Prescription Reimbursement Form | Form for Optum Rx prescriptions | Download Link