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Forms and Links
Forms and Links
Printable Forms
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- American Fidelity Claim Forms
- Express Script - Register for your account
- Express Scripts - Prescription Card and Documentation
- EyeMed Enrollment/Change - Form to fill out
- PEEHIP - Coordination of Benefits Form
- PEEHIP - Flexible Spending Account (FSA) and Dependent Care (DCA) - Understanding your benefits for these plans
- FSA Orthodontia Form
- PEEHIP - New Enrollment and Status Change - Form to be mailed
- PEEHIP Premium Assistance Application
- PEEHIP - Premiums
- PEEHIP - Understanding your PEEHIP benefits as a new employee
- PEEHIP Wellness Healthcare Provider Screening Form
- RSA Online Account
- RSA/PEEHIP Change of Address
- RSA-1 Deferred Compensation Plan - Link for documentation and registration
- Southland Benefits - Request a card, see coverage/claims for Optional Coverage Plans (Dental, Cancer, Indemnity, Vision)
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- Purchase Order Form (MUST BE PRINTED WITH COLOR)
- Expense Voucher (Updated 08-01-2024)
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Links
- American Fidelity
- Express Scripts – Register for Your Account
- Express Scripts – Prescription Card and Documentation
- Eye Med – Vision Insurance Option
- PEEHIP – Annual Wellness Form for Physician
- PEEHIP – Coordination of Benefits Form
- PEEHIP – Flexible Spending Account – Understanding Your Benefits for FSA and Dependent Care Forms
- PEEHIP – New Enrollment and Status Change - Options that cannot be completed online
- PEEHIP - Premium Assistance Application
- PEEHIP - Premiums
- PEEHIP – RSA Online Account
- PEEHIP – FSA Orthodontia Form
- Southland Benefits – Request a Card, See Coverage for Optional Coverage Plans
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