Claim Form – Medical Expenses (PDF - 115 KB)
To obtain a reimbursement for prescription drugs, paramedical or eye care, or ambulance transportation, see How do I submit a medical expense claim?

Claim Form – Dental Care (PDF - 48 KB)
To obtain a reimbursement for dental care, see How do I submit a dental care claim?

Claim Form – Dental Care in case of an accident (PDF - 48 KB)
For reimbursement of dental care when the expenses are incurred following an accident. This care is reimbursable under the health insurance coverage.

Claim form - Health Spending Account (PDF - 41 KB)
For reimbursement of expenses using your Health Spending Account.

Direct Deposit of Benefits (PDF - 136 K)
To request the direct deposit of your benefit payments in your bank account.

Claim form - Medical Expenses/HSA (Health Spending Account) (PDF - 58 KB)
To obtain a reimbursement for prescription drugs, paramedical or eye care, or ambulance transportation and/or obtain reimbursement of expenses using your Health Spending Account, see How do I submit a medical expenses claim and/or a Health Spending Account claim?

Claim Form - Dental Care/HSA (Health Spending Account) (PDF - 302 KB)
To obtain a reimbursement for dental care and/or obtain reimbursement of expenses using your Health Spending Account, see How do I submit a dental care claim and/or a Health Spending Account claim?

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