Medicare / Medical Forms
Authorization to Disclose Medical Information for Customer Service (TPA 006)
Accidental Injury Report (TPA 005)
Other Insurance Verification Form (TPA 412)
Request for Predetermination of Medical Benefits (TPA 019)
Disability Statement of the Insured (TPA 610)
Flex/HSA Forms
Authorization to Disclose Medical Information for Customer Service TPA 006
Guide to Flexible Spending Account Online Access TPA 213
Flexible Spending Account Direct Deposit Form TPA 402