Helpful Forms

Summary of all medical benefits.

*Updated version coming soon.

Use this form to record your biometrics with your provider.

Click here to download, view and print form.

Mandatory Legal notice for all health plans.

*New version coming soon.

Beneficiary Designation Request

Click here to download, view and print form.

BCBS Plan Booklet (H.S.A. Plan)

Click here to download, view and print form.

BCBS Plan Booklet (HRA Plan With Wellness)

Click here to download, view and print form.

BCBS Plan Booklet (HRA Plan Without Wellness)

Click here to download, view and print form.

Disability Plan Summary (Railroad)

Click here to download, view and print form.

Disbaility Plan Summary (Non-Railroad)

Click here to download, view and print form.

Hospital Indemnity Plan Summary

Click here to download, view and print form.

EAP-New Directions Summary Plan Description

Click here to download, view and print form.

Adobe PDF Files

Adobe-Reader

All forms are in PDF file format.

To read and print a PDF file, you must have Adobe® Acrobat® Reader installed on your PC. You can download a version suitable for your system, free of charge, from Adobe.

Adobe also provides tools and information to help make Adobe PDF files accessible to users with visual disabilities at http://access.adobe.com.

Click here to download Acrobat Reader if the forms do not load correctly.

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