Aetna Form 

• Voluntary Life Insurance (Aetna) EOI 

HIPAA Forms

• Authorization for Release of Health Information
• Request to Inspect Health Information
•  Request to Amend or Correct a Record

Ameriben Forms

• Coordination of Benefits (COB)
• Accident Questionnaire
• Reimbursement Request
• Alternative Medicine Reimbursement Request
•  Request for Review of Denied Medical Claim

Medical Network Forms

•   Continuation of Coverage for Disabled Child

Beneficiary Designation Form

•  Beneficiary Designation  

Name and Address Change Forms

• City - Name and Address Change
• FPPA - Name and Address Change
•  PERA - Member Information

Benefits Change Form

•  Benefits Change Form

Prescription Forms

• Mail Order Refill Request
•  Maxor Reimbursement Request

Common Law Forms

• Application Instructions
• Request for Common Law Status
•  Common Law Affidavit

Reach Your Peak Forms

• Department Level Activity Form
• Fitness Tracking Form 
• Generic Tracking Form
•  Health Screening Form-Retirees out of area ONLY

City Clinic Forms

• New Patient Information Form
• Patient Health Survey
•  HIPAA Release for County Records

Vision Service Plan Form

•  VSP Out-of-Network Reimbursement Request

Flexible Spending Account HRA Forms

• FSA and HRA Reimbursement
• Dependent Day Care Reimbursement
•  Direct Deposit Authorization