- IMS (Insurance Management Services)

The forms below require Adobe Acrobat Reader. You may download the reader for free by clicking on the logo on the right.

Claims

Catamaran Prescription Claim Form Claim Information Form

Cobra

Cobra Notification Form

Dental

Dental Claim Form

Disability

Dependent Disability Form Disability Form Short Term Disability Form

Eligibility

Dependent Eligibility Verification Form Group Insurance Transactions Form Change Form Enrollment Form Request For SSN

FSA

Flexible Spending Account (FSA) Withdrawal Request Form

HRA

Health Reimbursement Arrangement (HRA) Withdrawal Request Form

IMS

Prospective Client Information Sheet

Legal

Authorization Form Beneficiary Designation Designation of Authorized Representative

Managed Care

Pre-determination Request Form Pre-determination Request Form (PT, ST & OT) Request for Precertification

Providers

Qualified Payment Amount (QPA) Dispute Form for Providers

Formulario en español - Las formas abajo requieren adobe acrobat reader.

Forma de orden Reordenar la forma Formulario de Autorizaciόn Formulario de Historia de Proveedores Formulario de informaciόn de la reclamaciόn Verificaciόn de elegibilidad del dependiente